Frequency of apoptotic bodies positively correlates with Gleason grade in prostate cancer

Apoptosis in operated small cell lung carcinoma is inversely related to tumour necrosis and p53 immunoreactivity

The present study was undertaken to analyse the extent of apoptosis in operated small cell lung carcinoma (SCLC) by using in situ labelling of the oligonucleosomal DNA fragments by terminal transferase. The extent of apoptosis was compared with the cell proliferation activity, as determined by Ki-67 immunohistochemistry; with the volume density of necrosis (per cent), as determined by the morphometric point counting method; and with the occurrence of immunohistochemically detectable p53 and bcl-2 proteins. By in situ labelling, remarkably high apoptotic indices (from 0.08 to 8.10 per cent) were seen in SCLC. A high percentage of SCLSs also showed an exceptionally high proliferation activity. Aberrant accumulation of p53 protein was seen in 37.5 per cent and bel-2 overexpression in 50 per cent of SCLCs. Necrosis was seen in 82.5 per cent of SCLCs. The extent of apoptosis was inversely related to the extent of tumour necrosis (P = 0.05) and to p53 protein accumulation (P = 0.008). A positive association was found between the extent of apoptosis and bel-2 immunoreactivity (P = 0.02). The apoptotic indices (per cent) correlated with the age (P < 0.05) and total smoking time of the patients (P = 0.06).

Apoptosis, cell proliferation and expression of Bcl-2 and Bax in gastric carcinomas: immunohistochemical and clinicopathological study

To clarify the relation between bcl-2 and bax protein (Bcl-2 and Bax) expression with regard to apoptosis and cell proliferation, 82 gastric carcinomas were immunohistochemically investigated. The significance of apoptosis for biological behaviour of the tumours was also examined. The apoptotic indices (AIs) were significantly lower in early-stage than in advanced-stage lesions (P<0.05), being positively correlated with the mitotic indices (MIs) (r=0.447, P<0.001). No association between either AIs or MIs and tumour size (diameter of intramural spreading) was noted. The AIs in the high Bcl-2-immunoreactive score group were significantly smaller than in either the low or the negative categories, whereas they were relatively elevated in the high Bax score group. In addition, an inverse correlation between Bcl-2 and Bax expression was revealed for both AIs and MIs. Although depth of tumour invasion and lymph node status were clearly associated with favourable outcome, no relation between survival rates and average values of either AIs or MIs, or immunoreactive scores for Bcl-2 and Bax was observed. These results indicate that in gastric carcinomas, apoptosis is closely associated with cell proliferation and expression of Bcl-2 and Bax, but appears likely to have no particular biological significance as a prognostic factor.

Low frequency of apoptosis in Epstein-Barr virus-associated gastric carcinoma with lymphoid stroma

In order to understand the character of Epstein-Barr virus (EBV)-associated gastric carcinoma with lymphoid stroma (GCLS), we examined cell proliferation and death in comparison with gastric carcinoma without prominent lymphoid stroma (conventional gastric carcinoma). The EBV-encoded small RNA I (EBER-1) and apoptotic cells were examined by in situ hybridization (ISH) and by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end-labeling (TUNEL), respectively, on formalin-fixed paraffin-embedded surgical specimens from 22 GCLSs and 23 conventional gastric carcinomas. Immunostaining was performed for the detection of Ki-67 antigen (Ki-67), P53 protein (P53) and bcl-2 oncoprotein (BCL-2). The percentages of apoptotic and Ki-67-positive cells were expressed as apoptotic indices (AI) and Ki-67 labeling indices (KI), respectively. EBER-1 was detected in 19 (86%) GCLSs in contrast to none in conventional carcinomas. Mean AI was 1.8 +/- 0.6 in the EBER-1-positive GCLSs and 3.3 +/- 1.7 in the conventional gastric carcinomas, the value being significantly lower in the former (p < 0.01). Mean KI was 40.0 +/- 10.8 in the GCLSs and 48.5 +/- 9.1 in the conventional gastric carcinomas, the value being significantly lower in the former (p < 0.05). P53 expression showed no significant difference between the 2 categories of carcinoma.

Bcl-2 expression is correlated with a low apoptotic index and associated with progesterone receptor immunoreactivity in endometrial carcinomas

A total of 103 endometrial carcinomas (endometrioid type), as well as 15 samples of normal (atrophic or proliferative phase) and 26 of hyperplastic endometrium, were immunohistochemically investigated for expression of Bcl-2, and oestrogen and progesterone receptors (ER and PR), and the results compared with findings for apoptosis and cell proliferation. Carcinoma cases were subdivided into tubular and solid components on the basis of tumour growth patterns. Immunopositivity for Bcl-2, ER, and PR in tubular components was significantly higher than in the solid category, being negatively associated with histological grading. Immunoreactivity scores revealed that Bcl-2 in the tubular group was positively correlated with PR but not ER, while its expression in normal and hyperplastic endometrium was closely linked with both. Apoptotic and mitotic indices (AI and MI) were both significantly lower in tubular than in solid areas. In the tubular areas, AI, values were significantly lower in the subgroup with a high level of Bcl-2 expression than in either low-level or negative groups. These results indicate that Bcl-2 expression may play a central role in the inhibition of apoptosis in endometrial carcinoma, in particular those cases with tubular components, possibly being associated with PR rather than ER. Changes in the propensity for apoptosis may be related to alterations of tumour growth pattern and of features of differentiation.

bcl-2 overexpression combined with p53 protein accumulation correlates with hormone-refractory prostate cancer

Seventy-seven men with histologically proven and newly diagnosed prostate cancer we investigated for the presence of bcl-2 protein overexpression and p53 protein accumulation 1 immunohistochemistry. Forty-five men had evidence of locally advanced and metastatic disease and we treated by means of hormone manipulation. Twenty-eight patients either failed to respond to initial hormone manipulation or relapsed within 37 months from diagnosis (median 20 months). Of the 77 cancers, 37 (48% showed bcl-2 overexpression at diagnosis. Twenty-seven of those were treated with androgen ablation and 2 (74%) had hormone-refractory disease (P = 0.0128). Twenty-three of 77 men (29.8%) had nuclear staining for p53 protein. Twenty-one of those were treated with hormone manipulation and 14 (66.6%) showed hormone resistance (P = 0.0012). Seventeen patients had both bcl-2 overexpression and p53 protein accumulation, 16 of whom were hormonally treated, with 13 (81.2%) having hormone-refractory disease (P < 0.0001). These findings suggest that the combined detection of p53 protein accumulation and bcl-2 overexpression may be useful in predicting hormone resistance in prostate cancer. By deregulating programmed cell death, alteration in these genes may prevent patients from responding to androgen ablation, or allow them to escape hormonal control of the disease.

Perineural invasion of prostate carcinoma cells is associated with reduced apoptotic index

BACKGROUND

Prostate carcinoma is often associated with perineural (PN) invasion. The common occurrence of this phenomenon has led to speculation regarding the mechanisms of this association, yet to date there have been no studies that clearly define biologic differences between PN and nonperineural (NPN) carcinoma cells. To explore the mechanisms underlying PN invasion by prostate carcinoma cells, the authors investigated the influence of neural components on the growth potential of prostate carcinoma cells.

METHODS

Proliferative and apoptotic activities of PN and NPN carcinoma cells were analyzed on whole-mount sections of human prostates using immunohistochemical techniques in conjunction with a polyclonal Ki-67 antiserum, and the terminal deoxynucleotidyl transferase (TdT) mediated dUTP biotin nick end labeling (TUNEL) technique, respectively.

RESULTS

The proliferative index (Ki-67 positive cells per 100 carcinoma cells) of PN carcinoma cells (median, 4.10) was higher than that of their intraprostatic, NPN counterparts (median, 3.25), although the difference was not statistically significant (median difference, 0.38; 95% confidence interval [CI] = -0.99 to 1.32; P = 0.52). In contrast, the apoptotic index (AI = apoptotic bodies per 1000 carcinoma cells) in the NPN carcinoma cells was significantly lower (median, 4.10), than the PN carcinoma cells (median, 7.23) with a median difference of -3.45 (95% CI = -5 to -1.39; P = 0.02). The authors also found that AI was lower in the carcinoma cells surrounding nerves with a large diameter (P = 0.0005).

CONCLUSIONS

These results suggest that PN invasion by prostate carcinoma cells may not be only a volume effect of growing carcinomas; the neural components may favor the growth of carcinoma cells by inhibiting apoptosis, presumably through a paracrine mechanism, and thereby facilitate the spread of carcinoma cells along nerves. The data also suggest that heterogeneity in growth potential of prostate carcinoma cells may be determined by their local microenvironments, such as an association with neural components.

Apoptosis in human gastric mucosa, chronic gastritis, dysplasia and carcinoma: analysis by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling

We examined the existence and distribution of apoptotic cells in human gastric mucosa, chronic gastritis, adenomatous dysplasias and carcinomas in 15 surgically removed stomachs in which dysplasia and carcinoma were found simultaneously. Serial sections were cut for immunohistochemistry for p53 oncoprotein and Ki-67 antigen, and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labelling (TUNEL). TUNEL signal-positive apoptotic cells were rare in normal mucosa, while a few apoptotic cells were noted in gastritic mucosa and intestinal metaplasia, intermingled with Ki-67 antigen-positive cells forming a generative cell zone. This suggests the cell-cycle-dependent apoptosis of gastric mucosa. The frequency of apoptotic cells per crypt was higher in incomplete than in complete metaplasia, implying greater underlying DNA damage in the former. TUNEL indices (TI: percentage of TUNEL-positive cells in tumour cells) were slightly higher in adenomatous dysplasias (4.9 +/- 2.1) than in carcinoma (3.9 +/- 1.1), but there was no no statistical difference. Ki-67 indices (KI: percentage of Ki-67 antigen-positive cells in tumour cells) were significantly (P < 0.05) higher in carcinomas than in dysplasias. Thus, gastric adenomatous dysplasias were characterized by relatively higher TI and lower KI, which might reflect a more static growth potential. The expression of p53 oncoprotein in cancer cells is thought to be an apoptosis-suppressing event, although its precise role remains to be elucidated. Overall, these results indicate that apoptosis plays a crucial part in the morphogenesis of gastritic mucosa including intestinal metaplasia, and that the process is correlated both with tumourigenesis and with proliferative activity.

Correlation of apoptosis with tumour cell differentiation, progression, and HPV infection in cervical carcinoma

AIMS

To clarify the significance of apoptosis in the progression of uterine cervical neoplasias, including cervical intraepithelial neoplasia (CIN), microinvasive carcinoma (MIC), and invasive squamous cell carcinoma (ISCC) categories, in relation to cell proliferation and human papilloma virus (HPV) infection.

METHODS

Forty six cases of CIN I/II, 75 of CIN III, 16 of MIC, and 44 of ISCC were examined using formalin fixed and paraffin wax embedded samples. The TdT mediated dUTP-biotin nick end labelling (TUNEL) method for detection of apoptotic cells was performed along with Ki-67 immunohistochemistry. Presence of HPV-DNA was confirmed by PCR-RFLP assay.

RESULTS

Apoptotic labelling indices, calculated after counting positive nuclei among at least 2000 nuclei, showed significant positive correlation with histological malignant grading in CIN and tumour cell invasion into stroma. In contrast, similar Ki-67 labelling index values were found in CIN, MIC, and ISCC. Although HPV-DNA was detected in 35/46 CIN I/II (76.1%), 53/74CIN III (71.6%), 9/16 MIC (56.3%), and 36/44 ISCC (81.8%), there was no apparent relation with the apoptotic labelling indices.

CONCLUSIONS

Apoptosis in cervical neoplasias may be closely related to tumour cell differentiation and progression. It also seems unlikely that HPV itself is directly related to pathways regulating apoptosis.

Apoptosis occurs more frequently in metastatic foci than in primary lesions of human colorectal carcinomas: analysis by terminal-deoxynucleotidyl-transferase-mediated dUTP-biotin nick end labeling

We examined the occurrence of apoptotic cell death in 15 advanced colorectal carcinomas with lymph-node and/or liver metastases by terminal-deoxynucleotidyl-transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL). TUNEL-positive cells were used to quantify the apoptotic index (AI: percentage of TUNEL-positive cells in carcinomatous cells). Similarly, Ki-67-positive cells were used to quantify Ki-67 labeling (KI: percentage of Ki-67-positive cells in carcinomatous cells) as a proliferative index. The mean AIs of primary colorectal carcinomas, lymph-node and liver metastases were 3.5%, 5.6% and 6.2% respectively. There was a significant group difference between primary carcinomas and lymph-node or liver metastases. The mean KIs of primary colorectal carcinomas, lymph-node and liver metastases were 51.8%, 60.1% and 61.7% respectively. There was a significant group difference between primary carcinomas and lymph-node or liver metastases. In addition, there was a close positive relationship between the AI and MI per specimen. There was no apparent correlation between AI or MI and the expression of nuclear p53 of cancer cells. These results suggested that cell proliferation and loss (apoptosis) were more frequent in metastatic foci than in primary lesions, and that apoptosis might reflect not only cell loss but also the proliferative activity of human colorectal carcinomas.

Apoptosis and Expression of the Proto-Oncogenes bcl-2 and p53 and the Proliferation Factor Ki-67 in Human Medullary Thyroid Carcinoma

Apoptosis and Immunoreactivity for bcl-2, p53, and Ki-67 were studied in 21 patients with meduilary thyroid carcinoma (MTC). The DNA nick end labeling method was used to assess apoptosis. The relationships between the different factors were analyzed, as were their relations to clinicopathologic data, including survival. More than 80% of the tumors harbored apoptotic cells. Tumors in individuals who had died of the MTC disease had a higher percentage of apoptosis. All cases demonstrated immunoreactivity to bcl-2 disease-free individuals had a higher rate than those with recurrent disease. No obvious pattern could be discerned in the relation of p53 or Ki-67 to the outcome of the disease. An inverse correlation between bcl-2 and apoptosis (r=-0.81; p < 0.01) was demonstrated. bcl-2 was significantly (p = 0.014) associated with apoptosis even after taking both p53 and Ki-67 into consideration, but these two factors were unrelated to apoptosis. None of the factors studied were correlated to crude survival, either in univarlate or in muiltivariate analyses. This study established that bcl-2 immunoreactivity is closely associated with apoptosis in MTC, suggesting that a down-regulation of the bcl-2 protein is related to a more aggressive growth rate and might be a useful marker for the evaluation of MTC.

Association between the apoptotic index and established prognostic parameters in endometrial adenocarcinoma

The aim of this study was to determine if the apoptotic index can be readily determined for endometrial carcinoma in hysterectomy specimens and to establish if any association exists between the apoptotic index and tumour grade and stage. The apoptotic index, defined as the percentage of morphologically identified apoptotic cells and apoptotic bodies in 3000 tumour cells, was calculated for 15 adenocarcinomas of the endometrium. An association between apoptotic index and tumour grade and stage was sought. Two grade 3 adenocarcinomas of endometrium had a higher apoptotic index (5.15% to 6.43%) than 13 grade 1 and 2 lesions (1.18% to 3.8%) and formed a distinct group in this series. No association between apoptotic index and tumour stage was demonstrable. Apoptotic index can be readily estimated in routine hysterectomy specimens for endometrial adenocarcinoma. A high apoptotic index shows an association with features normally correlated with a poor clinical outcome although its value as an independent prognostic index has yet to be established.

Apoptosis and cellular proliferation in oesophageal squamous cell carcinomas: differences between keratinizing and nonkeratinizing types

To assess cell death and cellular proliferation activity, the apoptosis index, the Ki67 proliferative index and overexpression of p53 protein were evaluated in 69 oesophageal squamous cell carcinomas (ESCC), all surgically resected from Japanese patients. Apoptosis was examined by Gavrieli's method in histological sections, and proved to be significantly related to keratinization and ESCC progression. Overall labelling indices were 15.68 +/- 4.04 (positive/1,000 nuclei) and 6.79 +/- 0.64 respectively, in keratinizing and nonkeratinizing types. The apoptosis labelling index increased, especially in keratinizing lesions, from 4.50 +/- 0.59 with cancer invasion to mucosa through 11.46 +/- 2.70 with involvement of the submucosa up to 21.18 +/- 3.72 in cases of penetration to the muscularis propria or adventitia. The relationship between apoptosis, Ki67 scores and p53 expression was determined in identical cancer nests on serial sections. An inverse correlation was shown between the apoptosis score and the Ki67 score in both keratinizing and nonkeratinizing types. There was no significant correlation between apoptosis score and p53 expression, either overall or separately in keratinizing or nonkeratinizing types of ESCC. Our results suggest that a mechanism of induction of apoptosis similar to that operating in normal epidermis acts in keratinizing ESCC, and that as tumour volume increases, single cell death becomes more frequent.

The frequency of apoptosis correlates with the prognosis of Gleason Grade 3 adenocarcinoma of the prostate

BACKGROUND

Although localized carcinomas are predominantly moderately differentiated (Gleason Grade 3), they demonstrate markedly different rates of progression. Previously, the authors reported a correlation between apoptosis and the malignant characteristics of carcinoma in the mouse prostate reconstitution model system and between apoptosis and Gleason grade in the human tumor. This study was undertaken to determine whether the frequency of apoptosis correlates with prognosis and to compare the prognostic significance of the apoptotic index with other prognostic features in Gleason Grade 3 carcinomas.

METHODS

The apoptotic and mitotic indices of malignant and nonmalignant epithelium in 28 consecutive radical prostatectomy specimens were determined for a carcinomas composed entirely of Gleason sum 6 (primary Grade 3, secondary Grade 3) with a clinical stage T2 classification. Each patient was followed for 5-9 years (median 6, years). The indices, defined as the number of apoptotic and mitotic bodies in an H & E-stained section per 100 grids delineated by an ocular measuring field, were determined. The actuarial time to progression, defined as a sustained rise in the serum prostate specific antigen level greater than or equal to 0.4 ng/ml, was correlated with the apoptotic index, the mitotic index, tumor volume, and pathologic stage.

RESULTS

Neither pathologic stage nor tumor volume differed significantly between the group of 19 patients (68%) with no progression and the other 9 whose tumor progressed. The median apoptotic index of the carcinomas was 0.87 (range, 0.12-3.91). For patients with a low apoptotic index (< 0.87), the actuarial progression rate at 5 years was 7% +/- 14% (+/- 2 SE) compared with 50% +/- 26% for those with a high apoptotic index (P < 0.007). Mitotic index had no prognostic significance.

CONCLUSIONS

In carcinoma of the prostate, apoptosis can be recognized in standard H & E sections and quantitated by light microscopy. The apoptotic index may provide additional prognostic information in the predominant grade of early stage carcinoma. Cancer 1995; 75:522-9.