Emanuels A G, Burger M P, Hollema H, Koudstaal J
Department of Obstetrics and Gynecology, Academisch Ziekenhuis Groningen, The Netherlands.
Hum Pathol. 1996 Aug;27(8):807-11. doi: 10.1016/s0046-8177(96)90453-0.
A key prognostic parameter for vulvar carcinoma is the presence of lymph node metastases. Determination of proliferation markers has been suggested as a method to predict lymph node metastases in several tumor types. If this were true in vulvar carcinomas, reduced surgical therapy for patients with low-risk vulvar carcinoma could be considered. The authors analyzed whether the proliferation-associated markers silver nucleolar organizer region (Ag-NOR) and Ki-67 are predictors for inguinofemoral lymph node metastases in women with vulvar carcinoma. The authors also analyzed whether these proliferation markers are interrelated. Data were obtained from samples of 145 patients with T1/T2 squamous cell carcinoma of the vulva who were treated with vulvectomy and bilateral lymphadenectomy. None of these patients received preoperative therapy, and the invasion depth of the tumors was more than 1 mm. The median age was 71 years. The group consisted of 67 patients with differentiation grade 1, 64 with grade 2, and 18 with grade 3; 22% (15 of 67) of the patients with grade 1, 45% (29 of 64) with grade 2, and 43% (six of 14) with grade 3 had lymph node metastases. Formalin-fixed, paraffin-embedded sections were stained for proliferation markers Ag-NOR and MIB-1 (an equivalent of Ki-67 for fixed material). Both parameters were scored at the tumor stroma interface. Ag-NOR number and areas were quantified by interactive image analysis and Ki-67 index was scored microscopically with a grid. No relation was found between Ki-67 or Ag-NOR and lymph node metastases. A relation was found between Ki-67 and mitotic index (MI), but not between Ag-NOR and MI or Ki-67 index. Therefore, it is questionable whether Ag-NOR is, indeed, a marker for proliferation. The authors conclude that quantitation of Ki-67 and Ag-NOR does not contribute to the prediction of inguinofemoral lymph node metastases in squamous cell carcinoma of the vulva.
外阴癌的一个关键预后参数是淋巴结转移的存在。在几种肿瘤类型中，增殖标志物的测定已被建议作为预测淋巴结转移的一种方法。如果在外阴癌中也是如此，那么对于低风险外阴癌患者可以考虑减少手术治疗。作者分析了增殖相关标志物银核仁组织区（Ag-NOR）和Ki-67是否可预测外阴癌女性腹股沟股淋巴结转移。作者还分析了这些增殖标志物是否相互关联。数据来自145例接受外阴切除术和双侧淋巴结清扫术的T1/T2期外阴鳞状细胞癌患者的样本。这些患者均未接受术前治疗，肿瘤浸润深度超过1mm。中位年龄为71岁。该组包括67例分化1级患者、64例2级患者和18例3级患者；1级患者中有22%（67例中的15例）、2级患者中有45%（64例中的29例）、3级患者中有43%（14例中的6例）发生了淋巴结转移。用福尔马林固定、石蜡包埋的切片进行增殖标志物Ag-NOR和MIB-1（固定材料中相当于Ki-67的标志物）染色。两个参数均在肿瘤与基质界面处进行评分。通过交互式图像分析对Ag-NOR数量和面积进行定量，并用网格显微镜对Ki-67指数进行评分。未发现Ki-67或Ag-NOR与淋巴结转移之间存在关联。发现Ki-67与有丝分裂指数（MI）之间存在关联，但Ag-NOR与MI或Ki-67指数之间不存在关联。因此，Ag-NOR是否真的是一种增殖标志物值得怀疑。作者得出结论，Ki-67和Ag-NOR的定量分析对外阴鳞状细胞癌腹股沟股淋巴结转移的预测没有帮助。
