Del Vecchio M T, Spina D, Lazzi S, Bruni A, Funtò I, Mattei F M, Fornaini M, Luzi P, Tosi P
Sezione di Urologia, Azienda Ospedaliera Senese, Siena.
Pathologica. 1997 Aug;89(4):390-6.
A minority of stage I renal cell cancers have a bad prognosis, a minority of those in stage II-IV may behave favorably. Are there parameters which characterize such cases? In this study, a number of qualitative and quantitative parameters are used to detect differences between cases with at least 9 years of survival and those with a survival of less than 9 years.
133 cases of renal cell cancer were subdivided into stage subgroups: Robson's I; Robson's II-IV. The following data and parameters were registered and/or measured: sex, stage, tumor size, histological type, mean nuclear profile area (mA) and pleomorphism (standard deviation of mean nuclear profile area--SDA) nuclear grade (NG) and combined nuclear grade (CNG), DNA index, cell proliferation, as determined by mitotic index (MI), per cent of PCNA positive cells (PCNA + cells %), per cent of S-phase cells (SP cells %), p53 and EGFR expression, intratumoral T lymphocytes.
Older patients have a worse prognosis independently of the stage. Stage is the most discriminant qualitative parameter; tumor dimensions and both nuclear and combined nuclear grade are important too. Mean nuclear profile area and pleomorphism are also discriminant, while no prognostic value of histological type is shown and histology is not related to other parameters. Higher DNA index characterizes cases with worse prognosis, as well as MI, SP cells %, PCNA + cells %, and EGFR expression. No significant differences are detected for p53 expression and lymphoid infiltrates. A minority of patients with stage I tumors die within 9 years of diagnosis. They are older than survivors with the same stage, their tumors have larger nuclear area and greater pleomorphism, and are more frequently aneuploid with higher DNA index. A minority of patients with stage II-IV tumors survive at least 9 years from the time of diagnosis. They are younger than non-survivors in the same stages and have lower MI and PCNA positivity in the tumors, while other parameters are not discriminant.
少数I期肾细胞癌预后不良，少数II-IV期肾细胞癌预后可能良好。是否存在能够表征此类病例的参数？在本研究中，使用了一些定性和定量参数来检测生存至少9年的病例与生存不足9年的病例之间的差异。
133例肾细胞癌病例被分为不同分期亚组：罗布森I期；罗布森II-IV期。记录和/或测量了以下数据和参数：性别、分期、肿瘤大小、组织学类型、平均核轮廓面积（mA）和多形性（平均核轮廓面积标准差-SDA）、核分级（NG）和联合核分级（CNG）、DNA指数、细胞增殖（通过有丝分裂指数（MI）确定）、PCNA阳性细胞百分比（PCNA +细胞%）、S期细胞百分比（SP细胞%）、p53和EGFR表达、肿瘤内T淋巴细胞。
年龄较大的患者无论分期如何预后都较差。分期是最具鉴别力的定性参数；肿瘤大小以及核分级和联合核分级也很重要。平均核轮廓面积和多形性也具有鉴别力，而组织学类型未显示出预后价值且组织学与其他参数无关。较高的DNA指数表征预后较差的病例，MI、SP细胞%、PCNA +细胞%和EGFR表达也是如此。p53表达和淋巴细胞浸润未检测到显著差异。少数I期肿瘤患者在诊断后9年内死亡。他们比同分期的幸存者年龄更大，其肿瘤核面积更大且多形性更高，并且更频繁地为非整倍体且DNA指数更高。少数II-IV期肿瘤患者从诊断时起至少存活9年。他们比同分期的非幸存者年龄更小，肿瘤中的MI和PCNA阳性率更低，而其他参数无鉴别力。
