The expression of proliferating cell nuclear antigen in paraffin sections of peripheral, node-negative non-small cell lung cancer

Proliferating cell nuclear antigen promotes cell proliferation and tumorigenesis by up-regulating STAT3 in non-small cell lung cancer

Proliferating cell nuclear antigen (PCNA) functions as a bridging molecule, which targets proteins that have distinct roles in cell growth. The expression of PCNA is dysregulated in some tumors and takes part in the progression of oncogenesis. However, the roles of PCNA in the progression of non-small cell lung cancer (NSCLC) remain unknown. The present study aimed to investigate the function of PCNA in the occurrence and development of NSCLC and its underlying molecular mechanisms. Western blotting, RT-PCR, and immunohistochemistry assays were used to detect the expression pattern of PCNA in NSCLC tissues and cells. A log rank test was performed to compare the overall survival (OS) of patients with high/low expression of PCNA. Besides, the relationship between PCNA and signal transducer and activator of transcription-3 (STAT3) proteins were evaluated. Then, MTT, flow cytometry, clonal formation, and in vivo xenograft assays were conducted to investigate the effects of PCNA/STAT3 on cell growth, clonal formation, apoptosis, and tumorigenesis. Results showed that PCNA expression was elevated in NSCLC tissues and cells and it could combine with STAT3 and increased its expression and phosphorylation. Moreover, the expression of PCNA showed a positive correlation with the TNM grade and occurrence rate of the lymphatic metastasis and poor prognosis of NSCLC patients. Overexpression of PCNA promoted cell proliferation, clonal formation, and tumorigenesis in lung cancer cells and inhibited cell apoptosis. In contrast, these effects were inhibited when knockdown of STAT3. In conclusion, this study demonstrates that PCNA functions as an oncogene in the progression of NSCLC through up-regulation of STAT3. These findings point to a potentially new therapeutic strategy for NSCLC.

Blood vessel invasion as a strong independent prognostic indicator in non-small cell lung cancer: a systematic review and meta-analysis

Background and Objective

Blood vessel invasion plays a very important role in the progression and metastasis of cancer. However, blood vessel invasion as a prognostic factor for survival in non-small cell lung cancer (NSCLC) remains controversial. The aim of this study is to explore the relationship between blood vessel invasion and outcome in patients with NSCLC using meta-analysis.

Methods

A meta-analysis of published studies was conducted to investigate the effects of blood vessel invasion on both relapse-free survival (RFS) and overall survival (OS) for patients with NSCLC. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used to assess the strength of this association.

Results

A total of 16,535 patients from 52 eligible studies were included in the systematic review and meta-analysis. In total, blood vessel invasion was detected in 29.8% (median; range from 6.2% to 77.0%) of patients with NSCLC. The univariate and multivariate estimates for RFS were 3.28 (95% CI: 2.14–5.05; P<0.0001) and 3.98 (95% CI: 2.24–7.06; P<0.0001), respectively. For the analyses of blood vessel invasion and OS, the pooled HR estimate was 2.22 (95% CI: 1.93–2.56; P<0.0001) by univariate analysis and 1.90 (95% CI: 1.65–2.19; P<0.0001) by multivariate analysis. Furthermore, in stage I NSCLC patients, the meta-risk for recurrence (HR = 6.93, 95% CI: 4.23–11.37, P<0.0001) and death (HR = 2.15, 95% CI: 1.68–2.75; P<0.0001) remained highly significant by multivariate analysis.

Conclusions

This study shows that blood vessel invasion appears to be an independent negative prognosticator in surgically managed NSCLC. However, adequately designed large prospective studies and investigations are warranted to confirm the present findings.

Immunohistochemical markers of prognosis in non-small cell lung cancer: a review and proposal for a multiphase approach to marker evaluation

Characteristics of the tumour that affect and predict the survival outcome of patients with cancer are prognostic markers for cancer. In non-small cell lung carcinoma (NSCLC), stage is the main determinant of prognosis and the basis for deciding options for treatment. Patients with early-stage tumour are treated by complete surgical resection, which is curative in 40-70% of patients. That there are other factors important in determining the biology of these tumours, especially genes that have a role in metastasis, is indicated. Such factors could potentially be used to further classify patients into groups according to substages that may be treated differently. During the past decade, a large number of proteins that are putatively important in carcinogenesis and cancer biology have been studied for their prognostic value in NSCLC, but none of them have been proved to be sufficiently useful in clinical diagnosis. Several markers (epidermal growth factor receptor, human epidermal growth factor receptor 2, Ki-67, p53 and Bcl-2) have been studied exhaustively. Ki-67, p53 and Bcl-2 are suggested to be important but weak prognostic markers, by meta-analyses of the results. Cyclin E, vascular endothelial growth factor A, p16(INK4A), p27(kip1) and beta-catenin are promising candidates, but require further study in large randomised clinical trial samples by using standardised assays and scoring systems. Some issues and inconsistencies in the reported studies to date are highlighted and discussed. A guideline for a multi-phase approach for conducting future studies on prognostic immunohistochemistry markers is proposed here.

The change of proliferating cell nuclear antigen and apoptosis of the MM46 mammary cancer cells of the mouse after single high-dose irradiation

The effects of intraoperative radiotherapy on tumor cells were elucidated by immunohistochemical examination of changes in the level of proliferating cell nuclear antigen. In addition, the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling method was used to examine the level of apoptosis in mouse MM46 tumor cells after a single high dose of irradiation (30 Gy, 6 MeV). A significant decrease in the number of tumor cells compared to controls was observed on the 3rd, 7th, and 14th days following irradiation, but not on the 1st day. Consistent with these results, the proliferating cell nuclear antigen labeling index of irradiated cells decreased significantly on the 3rd, 7th, and 14th days following irradiation, but not on the 1st day. By comparison, the regrowth area on day 14 only showed no difference compared to the control group. The apoptotic index increased on the 7th and 14th day after irradiation, but at a lower rate than the observed decrease in the level of proliferating cell nuclear antigen. We speculate that the major mechanism of single high-dose radiation effect is inhibition of DNA synthesis.

A novel t(2;20)(q35;p12) in embryonal rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood, accounting for 5%-8% of all pediatric malignancies. RMS can be categorized into several subtypes, including embryonal RMS (ERMS), the botryoid and spindle cell variants of ERMS, and alveolar RMS (ARMS). The t(2;13)(q35;q14) and the variant t(1;13)(p36;q14) are seen in a majority of ARMS cases. In contrast, the embryonal subtype of rhabdomyosarcoma has not been associated with a recurring chromosomal translocation. We describe here a novel chromosomal t(2;20)(q35;p12) occurring in a case of childhood RMS with embryonal histology. It is notable that this translocation harbors breakpoints at or near the locus of the PAX3 gene, which is involved in the most common recurring translocation associated with ARMS.

Prognostic significance of K-ras, p53, bcl-2, PCNA, CD34 in radically resected non-small cell lung cancers

The aim of this study was to investigate the prognostic significance of a panel of biological parameters in patients with radically resected non-small cell lung cancers (NSCLC). 269 cases with pathological stage I-IIIA NSCLC were retrospectively analysed. Immunohistochemistry was performed to detect protein expression of p53, bcl-2, proliferating cell nuclear antigen (PCNA) and CD34. Polymerase chain reaction (PCR)/direct nucleotide sequencing method was used to detect mutations in K-ras (codons 12, 13, 61, exons 1-2). The Kaplan-Meier estimates of survival were calculated for clinical and biological variables using the Cox model for multivariate analysis. Histological subtype and the pathologic tumour extension (pT) were the most powerful clinical-pathological prognostic factors for survival (P=0.030 and P=0.031, respectively), whereas among the biological parameters, p53 overexpression (P=0.032) and K-ras mutation (P=0.078) had a negative prognostic role, as demonstrated by multivariate analysis. Conversely, bcl-2, PCNA and CD34 expression were not correlated with survival. Statistically significant associations between p53 expression and the squamous cell carcinoma (SCC) subtype, bcl-2 expression and SCC subtype, K-ras mutation and p53 negative expression, p53 and bcl-2, bcl-2 and PCNA overexpression were observed. In conclusion, some biological characteristics such as the K-ras and p53 status may provide useful prognostic information in resected NSCLC patients, in addition to the classical clinico-pathological parameters. However, further studies are needed to clarify the value of adopting biological prognostic factor into clinical practice.

Radiotherapy alone in technically operable, medically inoperable, early-stage (I/II) non-small-cell lung cancer

PURPOSE

To investigate the effectiveness of high-dose, curative radiotherapy (RT) given alone in technically operable, but medically inoperable, patients with early-stage (I-II) non-small-cell lung cancer (NSCLC).

METHODS AND MATERIALS

Computerized and manual searches were done to identify published reports dealing with curative RT for NSCLC. Relevant studies were identified and the information provided therein was extracted regarding patient and treatment characteristics, treatment outcome, and various pretreatment and treatment-related factors influencing outcome, as well as toxicity and quality-of-life issues.

RESULTS

Although a large variation of pretreatment and treatment characteristics was noted in the available studies, a median survival time of >30 months and a 5-year survival rate of up to 30% had been achieved. Accumulated experience seems to suggest that doses of at least 65 Gy with standard fractionation, or its equivalent when altered fractionation is used, are necessary for control of NSCLC. Smaller tumors seem to have a favorable prognosis, and the issue of elective nodal RT continues to be controversial. Analyses of patterns of failure have clearly identified local failure as the predominant pattern. Although a number of potential pretreatment patient- and tumor-related prognostic factors have been examined, none has been shown to clearly influence survival. Toxicity was usually low, but very high doses (e.g., 80 Gy) given with a conventional approach may carry a risk of an excessive rate of side effects.

CONCLUSION

High-dose, curative RT is an effective treatment modality in technically operable, but medically inoperable, patients with early-stage NSCLC.

The Ki-67 index and survival in non-small cell lung cancer: a review and relevance to positron emission tomography

PURPOSE

We reviewed the current literature to discover the range of studies covering tissue-based and noninvasive methods for determining tumor stage and the prognostic value of staging in non-small cell lung cancer.

DESIGN

Despite refinements in staging of non-small cell lung cancer, each stage remains heterogeneous because each stage contains patients who are at higher risk for recurrence than other patients within the same stage. Tissue-based and noninvasive methods have been investigated to complement tumor stage in assessing non-small cell lung cancer prognosis. The prognostic significance of tumor proliferation assessed by Ki-67 protein expression has been demonstrated in non-small cell lung cancer.

RESULT

Recent positron emission tomography studies have also shown both prognostic value in non-small cell lung cancer uptake of [F-18] fluorodeoxyglucose (FDG) and correlation between non-small cell lung cancer FDG uptake and tumor proliferation.

DISCUSSION

We reviewed the prognostic significance of Ki-67 expression in non-small cell lung cancer and related it to positron emission tomography.

Prognostic relevance of proliferating cell nuclear antigen and p53 expression in non-small cell lung cancer

Prognostic value of p53 and PCNA expression in non-small cell lung cancer (NSCLC) remains controversial. In this study we determined the relevance of these abnormalities in terms of overall survival and disease-free survival in 95 NSCLC patients who underwent curative pulmonary resection. Expression of p53 was found in 44 samples (45%), expression of PCNA-in 79 samples (83%), and expression of both markers-in 35 samples (36%). There was no relationship between expression of either protein and major clinicopathological characteristics. Median survival for patients with and without p53 expression was 36 and 33 months, respectively and 5-year survival probability-29 and 37%, respectively (P=0.73). Median survival for patients with and without PCNA expression was 36 and 27 months, respectively and 5-year survival probability-35 and 25%, respectively (P=0.60). There was no significant difference in overall survival between particular groups of patients with tumors carrying four possible p53/PCNA phenotypes. In multivariate analysis including patient age, sex, tumor stage, tumor type and differentiation, p53 and PCNA expression, the only variable important for survival was stage of disease. These results suggest the lack of prognostic relevance of p53 and PCNA expression in surgically treated NSCLC patients.

Peroxiredoxin I expression in oral cancer: a potential new tumor marker

This study investigates the applicability of the novel antioxidant protein, peroxiredoxin (Prx) I as a marker for tumor status in oral squamous cell carcinoma (SCC). Samples from 53 patients with SCC in the oral cavity were examined by immunohistochemistry. Correlations between the expression level of Prx I and proliferating cell nuclear antigen (PCNA), the clinical features of tumors, and their histopathological classifications were statistically analyzed. Cases exhibiting low Prx I expression level included significantly more with larger tumor mass cases (T-category, P=0.004), positive lymph node metastasis (N-category, P=0.015), advanced stage (P=0.002), and poorly differentiated cells (P=0.020). There was no significant difference between Prx I expression and the other indices.

Prognostic significance of proliferative activity in pN2 non-small-cell lung carcinomas and their mediastinal lymph node metastases

OBJECTIVE

To investigate the expression of proliferating cell nuclear antigen (PCNA) in both primary tumor and lymph node metastases of pathologic stage IIIA N2 non-small-cell lung carcinoma (NSCLC) and the relation to prognosis.

SUMMARY BACKGROUND DATA

Although the prognosis of pN2 NSCLC is poor in general, long-term survivors have been reported among patients with completely resected or clinical N0 disease and those with skip metastasis. However, few reports are available on preoperative prognostic predictors. Expression of PCNA is known to be associated with tumor proliferation and is correlated with the prognosis of several carcinomas.

METHODS

Clinicopathologic factors were investigated in relation to prognosis in 76 patients with pathologic stage IIIA pN2 NSCLC from whom resected surgical specimens were available from both the primary tumor and lymph node metastases for evaluation of PCNA expression.

RESULTS

A significant correlation was observed between PCNA labeling index in the primary tumor and that in lymph node metastases. The prognosis in patients with PCNA-negative primary tumor (5-year survival rate, 66.0%) was significantly more favorable than that of patients with PCNA-positive primary tumor (5-year survival rate, 21.5%). The prognosis in patients with PCNA-negative metastases was significantly more favorable than that of patients with PCNA-positive metastases. For clinical N2 disease also, the prognosis of patients with PCNA-negative primary tumor was favorable (5-year survival rate, 66.1%). Multivariate analyses showed that PCNA expression and complete resection were significant prognostic factors.

CONCLUSIONS

Preoperatively diagnosed N2 NSCLC exhibiting negative PCNA expression in primary tumor or lymph node metastases is expected to result in a favorable postoperative prognosis and may be an indication for primary resection.

Immunogold labelling of PCNA and Ki-67 antigen at the ultrastructural level in laryngeal squamous cell carcinoma and its correlation with lymph node metastasis and histological grade

Streptavidin-gold was used for the immunolocalization of PCNA and Ki-67 antigen at the ultrastructural level with a postembedding technique in biopsies of 15 patients with laryngeal squamous cell carcinoma. Positive immunoelectron staining was obtained in 9 cases for PCNA (60%) and in 8 cases for Ki-67 (53%). PCNA was predominantly found in heterochromatin of the nucleus of laryngeal carcinoma cells in a granular pattern. Positivity for PCNA was not found in nucleoli. In 4 cases, positive staining was observed both in nucleus and cytoplasm. In the cytoplasm, it was found to be present on the endoplasmic reticulum and on ribosomes throughout the cytoplasm. Ki-67 antigen was localized in the nucleus where it was associated with heterochromatin and euchromatin. It was also observed in nucleoli in all cases. Cytoplasmic localization of Ki-67 antigen was similar to that of PCNA. All 8 cases that were positive for Ki-67 were also positive for PCNA. Control incubations did not result in labelling with steptavidin-gold particles for both antigens. A significant correlation between PCNA and Ki-67 expression in association with pathological characteristics such as nodal status and histological grade was not found. Our data indicate that Ki-67 antigen staining correlates with PCNA labelling, whereas a relationship between proliferation markers and tumour progression was not found.

Biological prognostic factors for early stage completely resected non-small cell lung cancer

BACKGROUND AND OBJECTIVES

The different and unpredictable outcomes in early-stage non-small cell lung cancer patients requires urgent research concerning the biological pathway of this neoplasm. Our study investigated the frequency of expression and the clinicopathologic and prognostic significance of a series of biological markers in stage I and II resected non-small cell lung cancer.

METHODS

A total of 99 cases of pathologic stage I and II were analyzed. The mean follow-up of surviving patients was 41 months. The expressions of the following biological markers were tested: bcl-2, p53, Ki-67, angiogenesis, and tumor vessel invasion. Kaplan-Meier estimates of survival and time to recurrence were calculated for clinical variables and biological markers using Cox's model for multivariate analysis.

RESULTS

Tumoral vessel invasion was present in 22 (22%) pathologic samples, the angiogenesis mean value was 37 +/- 13, and median was 35; 13 (13%) patients showed positive immunostaining for bcl-2 oncoprotein. P53 oncoprotein expression was present in 48 patients (48.5%). All samples presented Ki-67 expression (mean value = 25.3 +/- 19.3, median = 20). The pathologic staging of the tumor was the most important independent prognostic factor for survival (P = 0.037) and for recurrence of disease (P = 0.040). Tumoral vessel invasion was the only marker with an independent predictive factor for survival and recurrence of disease in the group of patients without lymph node involvement (P = 0.02).

CONCLUSION

Our data do not support a relevant prognostic role for p53, bcl-2, or Ki-67 immunohistochemical markers in non-small cell cancer. Tumor vessel invasion was an independent predictive factor of poor outcome in the group of patients without lymph node involvement. Pathological stage was confirmed as the most important independent prognostic factor.

Transition from squamous cell carcinoma to adenocarcinoma in adenosquamous carcinoma of the lung

The heterogeneity of tumor cells is frequently observed in lung cancer, but the clonality of these cells has not yet been established. The distinct components of 12 lung adenosquamous carcinomas were compared by genetic alterations of p53 and K-ras, chromosomal abnormalities at 9p21 and 9q31-32, and immunohistochemical reactions. The immunoreactivity of p53 was consistent in both adenocarcinomatous and squamous cell carcinomatous components as well as in the transitional areas, retaining the morphological characteristics of the distinct components. The same p53 mutation was found in both components of each tumor with p53 overexpression. No K-ras mutations were detected in any of the tumors examined. Three of the four tumors with chromosomal abnormalities detected, one at 9p21 and two at 9q31-32, had coincident abnormalities between the distinct components, whereas one tumor deleted homozygously at 9p21 (D9S259) in the adenocarcinomatous component with loss of heterozygosity in the other component. The expression of squamous cell carcinoma-related antigen in adenocarcinomatous components was significantly higher than that of lung adenocarcinomas (57 +/- 5.8% vs. 1.0 +/- 0.5%, P < 0.0001), whereas Mucin 1 expression is less in these components (9.0 +/- 4.9% vs. 55 +/- 8.2%, P = 0.003). These results suggest monoclonal transition from squamous cell carcinoma to adenocarcinoma in lung adenosquamous carcinoma.

Expression of proliferating cell nuclear antigen and CD44 variant isoforms in the primary and metastatic sites of nonsmall cell lung carcinoma with intrapulmonary metastases

BACKGROUND

To the authors' knowledge the prognosis of patients with intrapulmonary metastases (PM) of nonsmall cell lung carcinoma (NSCLC) has not yet been clarified fully and little is known regarding the characteristic changes that occur during the metastatic process, nor of their clinical significance.

METHODS

Formalin fixed and paraffin embedded material of primary and metastatic lesions resected from 34 patients with PM of NSCLC were stained immunohistochemically with proliferating cell nuclear antigen (PCNA) and CD44 and its variant isoforms.

RESULTS

Patients with NSCLC expressing PCNA in the primary tumor site (79.4%) showed a significantly poorer survival (5-year survival rate of 20.2%) compared with the 5-year survival rate of 57.1% for patients not expressing PCNA in the primary tumor site (P = 0.048). Patients expressing PCNA in the metastatic site (88.2%) also showed a significantly poorer prognosis than those not expressing PCNA (P = 0. 036). Patients with squamous cell carcinoma expressed CD44 variant exon 6 (CD44v6) at a significantly higher rate than adenocarcinoma patients (P = 0.0164), but expression of CD44v6 was not a significant prognostic factor. Concordance of PCNA and CD44v6 expression between the primary and corresponding metastatic sites was observed in 65% of patients (22 of 34 patients) but no difference in prognosis was observed in relation to this concordance. Cox multivariate analyses indicated that expression of PCNA was a significant prognostic indicator for both primary and metastatic sites (P = 0.014 and P = 0.0095, respectively).

CONCLUSIONS

This study demonstrated that PCNA expression was a significant prognostic factor for both primary and metastatic lesions in PM patients. CD44v6 showed histogenesis of the tumor, but no relation with the prognosis could be ascertained.

Prognostic value of proliferating cell nuclear antigen immunostaining in pediatric rhabdomyosarcomas

BACKGROUND

The levels of proliferating cell nuclear antigen (PCNA) are almost negligible in long-term quiescent cells and increase dramatically during the cell cycle. Recently, the monoclonal antibodies to PCNA have been used to demonstrate the proliferative component of paraffin-embedded tumor tissues. It has been shown to be available as a simple histological marker of proliferative activity and the PCNA labeling index has been correlated with the prognosis of several malignant neoplasms.

METHODS

Formalin fixed, paraffin embedded tissue specimens of 29 primary pediatric rhabdomyosarcomas were immunostained by using an anti-PCNA monoclonal antibody (DAKO PCNA PC10). The relationship between the PCNA index and prognosis, clinicopathological features and survival were assessed retrospectively.

RESULTS

The mean PCNA index for the whole series was 54%. There was no correlation between PCNA index and any of the clinicopathological characteristics. However, patients having tumors with a high (> 54%) PCNA index demonstrated significantly lower survival rates than tumors with a low (< 54%) PCNA index (P = 0.01). Moreover, there were significantly more patients with relapse or progressive disease in the high PCNA index group (P = 0.005).

CONCLUSION

The PCNA labeling index can be a useful prognostic factor and a good indicator of recurrence and/or survival in patients with rhabdomyosarcoma.

Proliferating cell nuclear antigen in laryngeal cancer

The expression of proliferating cell nuclear antigen in paraffin sections from 154 cases of laryngeal squamous cell carcinoma were examined. There was significant difference in PCNA expression between the control group and cancer patients (p < 0.001). The mean score of PCNA was higher in patients with poor prognosis than in patients with satisfactory outcome after treatment (p < 0.05). There was no significant correlation between the PCNA count and the patient's age and sex, T and N stage and site of the tumour. Univariate analysis revealed that the PCNA score correlated with the patients' survival rates. In multivariate analysis the prognostic value of PCNA was on the statistical borderline (p = 0.049). In our study clinical features like N and T status had a more important influence on survival rate. Nevertheless it appears that the immunohistological examination of PCNA in paraffin section could be a complementary prognostic tool for laryngeal carcinoma. PCNA expression may also be a valuable tool for differentiating malignant from benign laryngeal epithelium.

Angiogenesis as a prognostic indicator of survival in non-small-cell lung carcinoma: a prospective study

BACKGROUND

Tumors acquire nutrients that are essential for continued growth and an avenue for dissemination to the rest of the body by inducing angiogenesis (i.e., the formation of new blood vessels). Preliminary studies involving a number of different kinds of cancer have indicated that an assessment of tumor angiogenesis may be useful in predicting disease outcome.

PURPOSE

In a prospective study, we evaluated the relationship between tumor angiogenesis and survival for 407 patients with non-small-cell lung carcinoma who were treated with potentially curative surgery.

METHODS

The study population consisted of 360 male and 47 female patients who underwent surgery consecutively at the Department of Surgery, University of Pisa, Italy, from March 1991 through December 1994. Follow-up lasted through February 1996, with a median follow-up for living patients of 29 months (range, 15-60 months). An anti-CD34 monoclonal antibody, which is specific for endothelial cells, and standard immunohistochemical techniques were used to measure angiogenesis in tumor samples. Angiogenesis was quantified in terms of microvessel counts; the counts for single, high-power microscopic fields (magnification x250) in the three most intense areas of blood vessel growth for each sample were averaged. The median microvessel count in this series was 20, and the counts were categorized as follows: 1) low versus high (< or =20 versus >20 microvessels) or 2) in five categories (1-10, 11-20, 21-30, 31-40, and > or =41 microvessels). Disease-free and overall survival during follow-up were assessed. Kaplan-Meier survival curves were modeled in a univariate analysis of patient and tumor characteristics; the Cox proportional hazards model was used in multivariate analysis. Reported P values are two-sided.

RESULTS AND CONCLUSIONS

In the univariate analysis, patients with larger tumors (P for trend <.00001), a more advanced tumor stage (P for trend <.00001), a greater degree of regional lymph node involvement (P for trend <.00001), or more vascularized tumors (high versus low microvessel count, P<.00001) experienced significantly reduced overall survival. When microvessel counts were analyzed in five categories, a highly significant trend (P<.00001) toward worse prognosis was observed with increasing tumor vascularity. In multivariate analysis, tumor microvessel count (P<.00001), tumor size (P = .0006), and regional lymph node status (P<.00001) retained independent prognostic value with respect to overall survival; among these variables, tumor microvessel count, considered as a continuous variable, was the most important, with a relative hazard of death of 8.38 (95% confidence interval = 4.19-16.78) associated with the highest microvessel counts.

IMPLICATIONS

An evaluation of tumor angiogenesis may be useful in the postsurgical staging of patients with non-small-cell lung carcinoma and in identifying subsets of patients who may benefit from different postsurgical treatments.

[Expression of proliferation markers PCNA and MIB 1 in verrucous squamous epithelial carcinoma of the oral cavity]

Expression of proliferation markers PCNA and MIB 1 was evaluated in 17 verrucous carcinomas and in five cases of normal squamous epithelium of the oral cavity. Immunohistochemistry revealed no significant differences in the proliferative activities. Highest expression was seen in the basal zones. Proliferative activity in more than 26% of cells is no longer compatible with verrucous carcinoma, but favours the diagnosis of squamous cell carcinoma.

Limitations of retrovirus-mediated HSV-tk gene transfer to pulmonary adenocarcinoma cells in vitro and in vivo

The utility of conferring chemosensitivity to pulmonary adenocarcinoma tumor cells by retrovirus-mediated transfer of herpes simplex virus thymidine kinase (HSV-tk) gene was assessed in vitro and in vivo. Retrovirus-mediated HSV-tk gene transfer to human adenocarcinoma cells (A549 cells) or mouse lung epithelial carcinoma cells (MLE cells) resulted in expression of HSV-tk mRNA and sensitivity to ganciclovir (GCV) in vitro. In nude mice, tumors produced from HSV-tk transduced MLE-7 cells regressed after 14 days of GCV treatment. However, in residual tumors, the size of the HSV-tk mRNA was altered and the sensitivity to further GCV treatment decreased. Tumor regression following GCV treatment was not observed in nude mice bearing HSV-tk-infected adenocarcinoma cells, MLE-15 and A549. Intratumor injection of HSV-tk producer cells failed to transfer HSV-tk gene to the A549 tumor cells in vivo. The lack of a 'bystander' effect, failure to achieve tumor regression, and loss of GCV sensitivity in some tumors in vivo may limit the utility of HSV-tk for therapy of pulmonary adenocarcinoma.

Clinical and flow cytometric prognostic factors in surgically treated squamous cell lung cancer

A five-year follow-up study of prognostic factors in 207 patients with squamous cell lung cancer (SqLC) radically treated with surgery was investigated. Cellular prognostic indicators for survival times, such as percentage of cells in the S-phase (S-phase fraction, SPF), proliferative index (PI, number of cells in S + G2/M phases) and DNA ploidy, in addition to well known clinical factors were studied. Patients with aneuploid tumours had significantly shorter survival period (P < 0.05) than patients with diploid tumours. However, proliferative rate of the tumours had no influence on patients' survival. Cox multivariate analysis showed that metastases to the neighbouring lymph nodes, tumour diameter > 5 cm and DNA aneuploidy of the tumour cells were the negative factors which affected patients survival. DNA ploidy did not depend on the clinical stage of the tumours.

Prognostic value of p53 in non-small cell lung cancer: relationship with proliferating cell nuclear antigen and cigarette smoking

p53 mutations are among the most frequent genetic alterations reported in human lung cancer. Although the prognostic value of altered p53 expression is still debated, it is accepted widely that estimation of the proliferation rate has an important prognostic role. Moreover, an association between certain types of human lung cancers and tobacco use is well known. Drawing from this background, we investigated the immunohistochemical expression of mutant oncogenic p53 protein, and related it to the smoking history of 61 patients with non-small cell lung carcinoma (NSCLC) and to the expression pattern of proliferating cell nuclear antigen (PCNA), which is considered to be an important negative prognostic factor in several neoplasms. We found p53 overexpression in 22 (36.1%) specimens, including 16 squamous carcinomas (41%) and six (27.2%) adenocarcinomas. PCNA nuclear staining was detected in 98.4% of the specimens, and a significantly higher PCNA expression score was found in all of the p53-positive samples. When the patient survival time was compared, p53 accumulation had a statistically significant negative prognostic value (P < .001). This was supported by a Kaplan-Meier survival percentage plot of immunohistochemically p53-undetectable specimens and p53-detectable specimens. These latter patients had a greatly reduced survival time. A relationship was established between p53 immunohistochemical detection and the smoking history of the patients. None of the specimens from the nonsmoking patients expressed immunohistochemically detectable p53 protein. Altered p53 expression was detected in 40.7% of smoking patients. Our findings support the hypothesis of involvement of p53 mutations in tobacco-induced carcinogensis and indicate that altered p53 expression plays an important prognostic role in NSCLC in smokers.

Neoangiogenesis and p53 protein in lung cancer: their prognostic role and their relation with vascular endothelial growth factor (VEGF) expression

Following up-regulation of an angiogenesis inhibitor by the wild-type p53 protein proven recently, we have analysed on the one hand the prognostic impact of microvessel count (MC) and p53 protein overexpression in non-small-cell lung carcinoma (NSCLC) progression and, on the other hand, the inter-relation between the microvascular pattern and the p53 protein expression. Moreover, we assessed the expression of vascular endothelial growth factor (VEGF), one of the pivotal mediators of tumour angiogenesis, in order to investigate its relation to p53 protein expression and MC. Tumours from 73 patients resected for NSCLC between March 1991 and April 1992 (median follow-up 47 months, range 32-51 months) were analysed using an immunohistochemical method. In univariate analysis, MC and p53 accumulation were shown to affect metastatic nodal involvement, recurrence and death significantly. Multiple logistic regression analysis showed an important prognostic influence of MC and nodal status on overall (P = 0.0009; P = 0.01) and disease-free survival (P = 0.0001; P = 0.03). Interestingly, a strong statistical association was observed between p53 nuclear accumulation and MC (P = 0.0003). The same inter-relationship was found in non-squamous histotype (P = 0.002). When we analysed the concomitant influence of MC and p53 expression on overall survival, we were able to confirm a real predominant role of MC in comparison with p53. With regard to VEGF expression, p53-negative and lowly vascularized tumours showed a mean VEGF expression significantly lower than p53-positive and highly vascularized cancers (P = 0.02). These results underline the prognostic impact of MC and p53 protein accumulation in NSCLC and their reciprocal inter-relationship, supporting the hypothesis of a wild-type p53 regulation on the angiogenetic process through a VEGF up-regulation.

Histologic evaluation of auricular cartilage grafts after discectomy in the rabbit craniomandibular joint

PURPOSE

The clinical use of auricular cartilage grafting after discectomy has been reported as a treatment in the terminal stage of internal derangement of the temporomandibular joint (TMJ). Although the occurrence of fibrous adhesions has been observed in such grafted joints, the exact tissue reaction to the graft is still not understood. The purpose of this study was to evaluate the histologic changes after discectomy and auricular cartilage grafting in the rabbit craniomandibular joint (CMJ).

MATERIALS AND METHODS

Unilateral discectomy of the left CMJ was performed in 28 Japanese white rabbits. Auricular cartilage harvested from the ipsilateral ear was grafted as a disc replacement in 14 animals (Group C), and the other 14 underwent wound closure immediately after discectomy (Group B). Two other rabbits (Group A) served as nonsurgically treated controls. Two rabbits from each experimental group were killed at 2, 4, 6, 8, 10, 12, and 24 weeks postoperatively. Microscopic observation of the specimens was performed in the parasaggital plane.

RESULTS

Complete resorption of the cartilage layer on the articular surface was observed within 4 weeks postoperatively in group B. Regeneration of a fibrous cartilage layer was observed in this group after 6 weeks, but the postoperative degenerative changes were so severe that the surface of the condyle and eminence was flattened. In contrast, the degenerative changes were milder in group C, although the grafted cartilage showed perforation and fragmentation from the sixth postoperative week onward. The condylar shape and cartilage layer were well preserved at all times.

CONCLUSIONS

These results suggest that the structure and function of the condyle may be preserved by auricular cartilage grafting after discectomy. However, the problems of adhesion and fragmentation need to be addressed.

Local increase in polymorphonuclear leukocyte elastase is associated with tumor invasiveness in non-small cell lung cancer

The production of tumor cell proteases is implicated in tumor cell invasion and metastasis. To determine whether lung cancer cells can produce polymorphonuclear leukocyte elastase (PMN-E), we measured the concentration of immunoreactive (ir)-PMN-E in the conditioned medium of seven lines of non-small cell lung cancer cells, EBC-1, LC-1sq, LK-2, A-549, PC-3, RERF-LC-MS, and RERF-LC-OK, and three normal lung epithelial cell lines, CCD-8Lu, WI-1003, and LL-24, by using a recently developed enzyme immunoassay (EIA). We measured the concentration of ir-PMN-E in extracts of 40 non-small cell lung cancers, and evaluated its association with the clinicopathologic findings in these patients. The ir-PMN-E level in the culture medium increased with time in six of the seven lines of lung cancer cells; the exception was PC-3. No detectable ir-PMN-E was secreted into the culture medium of the three lines of normal lung epithelial cells. The ir-PMN-E was detected in tissue extracts from 34 to 40 specimens at concentrations ranging from 0.11 to 15.5 micrograms/100 mg of protein. When 40 specimens of lung cancer were categorized by clinical stage of disease, the ir-PMN-E concentration was significantly higher in stage IIIB vs stages I, II, or IIIA. Similarly, the ir-PMN-E concentration was significantly higher in stage IIIA than in stage I. Evaluation of correlations between the ir-PMN-E concentration and patient characteristics showed that the ir-PMN-E level was significantly higher in T3 and T4 tumors than in T1 or T2 tumors. Analysis of prognostic factors in a group of 101 patients with non-small cell lung cancer demonstrated that those with high ir-PMN-E had a significantly shorter overall survival vs those with a low ir-PMN-E at the cutoff point of 3.5 micrograms/100 mg of protein. Multivariate analysis showed that ir-PMN-E was a significant porgnostic factor for early death (hazard ratio, 4.04; 95% confidence interval, 1.65 to 9.95) (p = 0.005), suggesting it was an independent marker for prognosis. Results suggest that the local production of PMN-E may be involved in the tumor invasion associated with a poor prognosis in patients with non-small cell lung cancer.

[Analysis of proliferating cell nuclear antigen (PCNA) expression in 24 cases of primary non-small cell pulmonary carcinomas and correlation with survival]

Proliferating cell nuclear antigen (PCNA) is a 36 kD nuclear protein involved in DNA replication that is believed to provide an indication of proliferation in some neoplasms. This study analyzes PCNA expression in 24 cases of primary non-small cell lung cancer using monoclonal PC-10 antibodies in paraffin embedded material. We found significant inter- and intra-tumoral variations in PCNA expression, and no statistically significant relation between the amount of PCNA expression and the size and location of tumors, index of mitosis, histological tumor type or patient age. We found a statistically significant relation (r = 0.47; p < 0.05) between survival and amount of PCNA expression in a sample of 19 cases, but no statistically significant differences in survival related to whether PCNA expression was slight (0-25), moderate (25%-50%) or high (> 50%), and no prognostic value for degree of PCNA expression.

Expression of proliferation-associated antigens in cervical carcinoma: correlations among indexes

Monoclonal antibodies recognizing proliferation-associated antigens can be employed in formalin-fixed, paraffin-embedded sections. The MIB1, PC10, 19A2, cytoplasmic p105 indexes, and mitotic index in hematoxylin and eosin stained preparations represent the growth, S-phase and mitotic fractions, respectively. The specimens consecutively taken from 194 patients with stage III cervical carcinoma were investigated immunohistochemically. Cancer cells that were positive for MIB1, PC10 and 19A2 showed a nuclear staining pattern. Mitotic cancer cells were strongly positive for p105 in their cytoplasm and also showed chromosomal p105 positivity. The mean indexes for MIB1, PC10, 19A2 and cytoplasmic p105 and the mitotic index in hematoxylin and eosin preparations were 43% (range, 18-74%), 26% (5-60%), 15% (0-60%), 2% (0-11%) and 0.6% (0-6.3%), respectively. The linear regression analysis showed only a very weak or no correlations between the MIB1, PC10, 19A2 and cytoplasmic p105 indexes among the patients (linear regression correlation coefficient r = 0.10 to 0.32). We conclude that (1) the MIB1 growth fraction, PC10 or 19A2 S-phase fraction, and the mitotic fraction show wide variations among patients with cervical carcinoma and (2) the PC10 or 19A2-positive S-phase fraction and the mitotic fraction of cervical carcinoma should not be used instead of the MIB1 growth fraction as equivalent to cycling cancer cell population.

Selected eicosanoids increase the proliferation rate of human colon carcinoma cell lines and mouse colonocytes in vivo

Eicosanoids have been implicated in colon carcinogenesis, but their role remains unclear. The levels of PGE2 are elevated in colon cancer tissues and in blood draining colon tumors. The effect of eicosanoids on the proliferation of colonic cells is unknown. We studied the effect of several prostaglandins (PGs) and leukotriene (LT)B4 on the proliferation rate of the human colon adenocarcinoma cell lines SW1116 and HT-29 and of 16,16-dimethyl PGE2 (dmPGE2) on the colon of BALB/c mice. PGs E2, F2 alpha, I2, the methyl ester of PGE2, dmPGE2, and LTB4 (10(-10), 10(-8), 10(-6) M), administered for up to 72 h, stimulated cell proliferation in SW1116 cells and all but PGF2 alpha and PGI2 stimulated proliferation in HT-29 cells. The proliferative effect was time- and concentration-dependent. However, in SW1116 cells the response to PGs was 'bell-shaped', being maximal at 10(-8) M, with the 10(-10) and 10(-6) M concentrations being less effective. In HT-29 cells, the addition of methyl groups to the PGE2 molecule increased the proliferative effect. None of these eicosanoids affected the distribution of these cells in the cell cycle or their rate of programmed cell death (apoptosis). dmPGE2 stimulated 3.6-fold the proliferation of colonocytes in normal BALB/c mice. This was determined by bivariate flow cytometric analysis of the expression of proliferating cell nuclear antigen (PCNA) in virtually pure populations of mouse colonocytes. dmPGE2 did not alter the cell cycle distribution of these cells. We conclude that several PGs as well as LTB4 stimulate the proliferation of human colon carcinoma cells in vitro, while dmPGE2 has a similar effect on mouse colonocytes in vivo. These findings raise the possibility that eicosanoids may contribute to colonic carcinogenesis by stimulating the proliferation rate of tumor cells in the colon.

Prognostic value of proliferating cell nuclear antigen (PCNA) immunostaining in neuroblastoma

Immunostaining for proliferating cell nuclear antigen (PCNA), a marker of cell proliferation, is being increasingly used to study the proliferative activity of tumors, and the PCNA labeling index has been correlated with the prognosis of several malignant neoplasms. Formalin-fixed, paraffin-embedded tissue specimens of 24 primary neuroblastomas were immunostained using an anti-PCNA monoclonal antibody and the PCNA index was calculated. Then the relationship between the PCNA index, prognosis, and various other factors was assessed, retrospectively. The mean PCNA index was 11.0%. Patients having tumors with a high PCNA index (> or = 11.0%) showed a significantly lower survival rate than those possessing tumors with a low PCNA index (P < 0.001). Moreover, the tumors showing N-myc amplification had a high mean PCNA index of 15.6%, while those without N-myc amplification had a low mean index of 1.7% (P < 0.01). The PCNA index was closely related to the prognosis of neuroblastoma and to N-myc amplification. It has the potential to be a useful prognostic indicator of the patients with neuroblastoma.

Rectal cancer: the influence of tumor proliferation on response to preoperative irradiation

PURPOSE

Regression of rectal carcinoma after preoperative irradiation is variable, likely reflecting differences in the physical and biologic properties of these tumors. This study examines the association between the pathologic response of rectal cancer after irradiation and its pretreatment proliferative state as assayed by the activity of the proliferative dependent antigens (Ki-67, PCNA) and mitotic counts.

METHODS AND MATERIALS

One hundred and twenty-two patients with locally advanced rectal cancer received preoperative irradiation followed by surgery. Pretreatment tumor biopsies were scored for the extent of Ki-67 and PCNA immunostaining and the number of mitoses per 10 high-powered fields. Postirradiation surgical specimens were examined for extent of residual disease.

RESULTS

The tumors of 38 of 122 patients (31%) exhibited marked pathologic downstaging (no residual tumor or cancer confined to the rectal wall) after preoperative irradiation. Two features were associated with the likelihood of marked pathologic regression after preoperative irradiation: tumor proliferative activity and lesion size. When stratified by lesion size, marked tumor regression occurred most frequently in smaller tumors with high Ki-67, PCNA, and mitotic activity compared to larger tumors with lower Ki-67, PCNA, and mitotic activity. Intermediate downstaging rates were seen for small or large tumors with moderate Ki-67, PCNA, and mitotic activity.

CONCLUSION

Tumor Ki-67, PCNA, and mitotic activity predicts the likelihood of response to irradiation, which may aid in formulating treatment policies for patients with rectal cancer.

Proliferating cell nuclear antigen may be superior to argyrophilic nucleolar organizer regions in predicting shortened survival of patients with non-small cell lung cancer

We examined proliferating cell nuclear antigen (PCNA) in 102 patients with surgically treated non-small cell lung cancer (NSCLC). PCNA labelling index (LI) tended to be higher in tumours of higher stages than those of early stages, in squamous cell carcinomas than adenocarcinomas, or in poorly differentiated adenocarcinoma than in well-differentiated. A positive correlation was observed between the PCNA LI and argyrophilic nucleolar organizer regions (Ag-NOR) count which we previously examined (r = 0.31, P = 0.002). In survival analysis of 79 patients who died of lung cancer, only age, stage and PCNA LI were found to be significant prognostic factors on multivariate analysis among seven potential prognostic factors including sex, age, year of operation, histological type, stage, Ag-NOR count, and PCNA LI. We conclude that PCNA may be superior to Ag-NOR in predicting shortened survival of patients with non-small cell lung cancer. PCNA staining can be performed with ease and it may be applied in a clinical laboratory on a routine basis to help predict prognosis of NSCLC.

Prognostic significance of peritumoural blood and lymphatic vessel invasion by tumour cells in T4 non-small cell lung cancer following induction therapy

We investigated the impact of new biological prognostic factors is in 28 patients receiving a median of two courses of cisplatin-based chemotherapy with (n = 14) or without (n = 14) radiation and operation for stage IIIB (T4) non-small cell lung cancer (NSCLC). After induction therapy, 5 patients had a complete and 21 a partial response; 2 had a stable disease. A complete resection was made in 26 patients (93%). Five patients (18%) had their primary tumour and involved vestiges completely sterilized. In the remaining 23, the majority of the tumours showed abnormalities in the p53 gene expression (56%), harboured proliferating cells (91%) and induced angiogenesis (91%). Peritumoural blood and lymphatic vessel invasion (PBLVI) by tumour emboli was observed in 6 tumours. With a median follow-up of 25 months, overall 3-year survival was 48%; disease-free survival (DFS) has not been reached yet. The only significant factor influencing DFS in multivariate analysis was PBLVI by tumour cells; PBLVI-positive patients had a significantly higher likelihood ratio (P = 0.000001) of developing metastasis than their PBLVI-negative counterparts. This study documents the prognostic implication of PBLVI by tumour cells in T4 NSCLC.

High cell proliferation activity determined by DNA flow cytometry and prognosis in epidermoid lung carcinoma

DNA aneuploidy and high cell proliferation activity determined by DNA flow cytometry are known to be associated with poor prognosis in many human malignancies. The aim of the present study was to determine the long-term prognostic value of DNA ploidy and cell proliferation activity in lung cancer. The material consisted of samples from 290 paraffin-embedded lung cancers (171 epidermoid carcinomas, 62 small-cell carcinomas, 26 adenocarcinomas, and 31 others), of which DNA ploidy and cell proliferation activity as defined by S-phase fraction (SPF) was determined by DNA flow cytometry. DNA aneuploidy was found in 61% of the tumours and the mean (+/- SD) SPF was 13.6 +/- 9.5%. DNA aneuploidy was associated with a high T-stage (p < 0.05) in epidermoid carcinoma, but not in small-cell carcinoma or adenocarcinoma. DNA aneuploidy and high SPF were associated with poor survival in epidermoid carcinoma. However, only SPF (relative risk (RR) = 1.80), N-(RR = 2.46) and M-stages (RR = 2.17) were statistically significant predictors of survival according to multivariate analysis. Regression-tree analysis showed that the prognostic value of SPF was restricted to localized (M0-stage) epidermoid carcinoma. Neither DNA aneuploidy nor SPF was associated with survival in small-cell lung carcinoma. In conclusion, SPF is an independent prognostic factor in epidermoid lung carcinoma.

PCNA immunostaining combined with AgNOR staining in esophageal squamous cell carcinoma to identify patients with a poor prognosis

Immunostaining of the proliferating cell nuclear antigen (PCNA) provides important information about cell kinetics and is easily performed on routinely obtained formalin-fixed, paraffin-embedded materials. We report herein the results of a retrospective study on PCNA staining in esophageal cancer undertaken to determine its significance. As this study indicated that immunoreactivity was preserved in specimens fixed within 24h, only 31 specimens from surgical patients were available for this investigation. The mean PCNA index of the patients without invasion to the adventitia (35.7 +/- 17.9) was significantly lower than that of those with invasion to the adventitia or neighboring structures (49.7 +/- 14.5), while the PCNA index did not correlate with other clinicopathologic parameters such as histologic type, lymph node metastases, or prognosis. However, when an analysis of PCNA staining was combined with an analysis of argyrophilic nucleolar organizer region (AgNOR) staining, a correlation with prognosis was found. In fact, seven patients with a high PCNA index (> or = 44) and AgNOR count (> or = 6) had a significantly poorer prognosis than the remaining 22 (P = 0.0014), and six of these seven patients died within 2 years. These results indicate that this combined evaluation may be useful for the identification of patients with a poor prognosis among those undergoing surgery for esophageal squamous cell carcinoma.

Comparative flow cytometric analysis of Ki-67 and proliferating cell nuclear antigen (PCNA) in solid neoplasms

The proliferation associated antigens, Ki-67 and proliferating-cell nuclear antigen (PCNA), have been widely used in studies assessing the growth fraction in human malignancies. It remains unclear, however, whether these markers yield similar assessments of proliferative activity in any given neoplasm. In this study, we compared Ki-67 and PCNA expression in 93 malignant solid neoplasms using bivariate flow cytometric analysis of these antigens and DNA content. The growth fractions measured by Ki-67 and PCNA were compared and correlated with acridine orange (AO) analysis and tumor grade. Our results indicate a significant difference between Ki-67 and PCNA values in neoplasms of low and intermediate grade (P = 0.002); Ki-67 values were significantly lower than those obtained by PCNA in this group. No statistical difference between Ki-67 and PCNA values was found in high grade neoplasms (P = 0.38). Analysis of different cell cycle compartments indicates that the observed difference in the positivity of these markers was due to their differential expression in the G0/1 segment of the cell cycle. We conclude that Ki-67 may better reflect the proliferative activity in solid neoplasms than does PCNA.

Proliferating cell nuclear antigen and Ki-67 in lung carcinoma. Correlation with DNA flow cytometric analysis

BACKGROUND

To study the prognosis of patients with lung carcinomas, the efficacy of proliferating cell nuclear antigen (PCNA) in ensuring both the proliferative activity defined using Ki-67 labeling and the cell cycle data obtained using flow cytometry was determined.

METHODS

The authors used immunostaining to study frozen and paraffin embedded sections of 165 surgically resected lung carcinomas [squamous cell carcinoma, n = 84; adenocarcinoma, n = 62; large cell carcinoma, n = 15; small cell carcinoma, n = 4] for the presence of PCNA and Ki-67 antibodies. Also studied were two parameter flow cytometric analysis of fluorescein isothiocyanate conjugated PCNA/propidium iodide for 165 fresh frozen tissues. Clinicopathologic data (sex, age, tumor stage, survival period, histologic type, degree of cell differentiation, and cellularity) were evaluated using the Statistical Analysis System.

RESULTS

The percentages of PCNA positive cells per 1000 nuclei were 52% of squamous cell carcinoma; 49% in adenocarcinomas; 76% of large cell carcinoma; and 63% of small cell carcinoma. Positive PCNA staining was significantly correlated with stage, cellularity, and DNA index. Calculation of logistic regression coefficients indicated an association between overall survivals and tumor cellularity (P < 0.0003), percentage of cells stained with PCNA antibody (P < 0.02), DNA pattern (aneuploid versus diploid) (P < 0.009), DNA index (P < 0.009), and percentage of cells in S-phase (P < 0.04). Both cellularity (P = 0.03) and DNA (P = 0.08) retained its independent level of significance by multivariate analysis.

CONCLUSIONS

In addition to clinical stage and histologic differentiation, both cellularity and DNA content may help predict the course of lung carcinomas.

High correlation with survival of proliferating cell nuclear antigen expression in mucoepidermoid carcinoma of the parotid gland

We tested the hypothesis that proliferating cell nuclear antigen can predict survival in patients with mucoepidermoid carcinoma. Formalin-fixed, paraffin-embedded, tissue resected specimens from 43 patients with no prior treatment for mucoepidermoid carcinoma of the parotid gland were immunostained with the PC10 monoclonal antibody to proliferating cell nuclear antigen with the peroxidase/antiperoxidase method. Proliferating cell nuclear antigen levels were defined as the number of nuclei with strong immunostaining divided by the total cell count and were expressed as percentages. Both univariate and multivariate analyses were performed on 12 additional prognostic variables to determine the relative proliferating cell nuclear antigen level to predict survival. The median proliferating cell nuclear antigen level was 7. Five percent of patients with proliferating cell nuclear antigen levels less than 7 died of their disease compared with 48% of those with proliferating cell nuclear antigen levels of 7 or more. Multivariate analysis indicates proliferating cell nuclear antigen to be the most important parameter in predicting survival. Thus the measurement of proliferating cell nuclear antigen is a useful predictor of survival for patients with mucoepidermoid carcinoma of the parotid gland.

Human non-small cell lung cancer: p53 protein accumulation is an early event and persists during metastatic progression

Mutations in the p53 tumour suppressor gene, with consequent accumulation of the p53 protein, are frequently observed in non-small cell lung cancer (NSCLC). Little is known, however, about the timing of their appearance or their maintenance through cancer progression and metastatic spread. We have examined the normal epithelium and a panel of bronchial lesions, including dysplastic, neoplastic, and metastatic lesions, for p53 immunoreactivity and for expression of proliferating cell nuclear antigen (PCNA). No p53 immunoreactivity was found in normal and hyperplastic epithelium, nor in squamous metaplastic lesions. Twenty out of 30 invasive tumours and 13 out of 17 in situ carcinomas adjacent to an invasive tumour showed p53 immunoreactivity. There was a strict correlation between the level of p53 expression in the non-invasive and the invasive components of the tumours. Five out of eight pairs of primary tumours and matching metastases expressed p53, at identical levels in both compartments. These data indicate that p53 overexpression can occur in the earliest recognized phase of NSCLC and that the alteration is maintained during progression from in situ to invasive carcinoma and metastatic spread. PCNA expression increased from early to advanced phases of NSCLC. High PCNA immunoreactivity was observed in tumours expressing high p53 levels. A significant association was observed for PCNA expression between preinvasive and invasive lesions.

Proliferating cell nuclear antigen and p53 expression as prognostic factors in T1-2M0 prostatic adenocarcinoma

The expression of proliferating cell nuclear antigen and p53 protein was analysed by immunocytochemical methods (PC10, CM1 antisera) in 139 patients with T1-2M0 prostatic adenocarcinomas followed-up for > 12 years. p53 protein was expressed in 21 (15%) tumours (15%), the fraction of positive nuclei being very low (mean SE, 1% +/- 0.7%). Accumulation of p53 protein in epithelial cells was independent of tumour stage and Gleason score, and had no effect on prognosis. In 4 cases, p53 protein was expressed only in stromal cells. The fraction of PCNA-positive nuclei (evaluable in 116 cases) was higher in T2 than in T1 tumours (p < 0.001); furthermore, high Gleason score was positively correlated with PCNA positivity (p < 0.001). A finding of over 5% of PCNA-positive nuclei predicted progression in T and M categories and were a sign of poor outcome. The fraction of PCNA-positive stromal-cell nuclei was related to T-category with a borderline significance (p = 0.06). In a multivariate analysis of the prognostic factors, independent predictors of survival included Gleason score (p < 0.001), fraction of PCNA-positive nuclei (p = 0.013), observation before therapy (p = 0.05), and T-category (p = 0.07) in that order of significance. The results suggest that overexpression of p53 protein is of marginal prognostic value in local prostatic adenocarcinomas, whereas direct measurement of cell proliferation by PCNA immunolabelling provides important prognostic information in T1-2M0 tumours, in addition to the Gleason score.

Angiogenesis: an indicator of metastasis in non-small cell lung cancer invading the thoracic inlet

We have attempted to identify a biologic rationale for the local aggressiveness and late treatment failure of resected non-small cell lung cancer involving the thoracic inlet. Tumor specimens from 28 patients who underwent a new transcervical approach were analyzed for the expression of tumor proliferative activity, suppressor-gene p53, intratumoral and peritumoral blood vessel invasion by tumor cells, the presence and degree of angiogenesis (induction of new capillaries and venules), and other biologic variables. Eighty-nine percent of the neoplasms were moderately or poorly differentiated, 89% expressed either an intermediate or high proliferative activity, 39% showed p53 aberrations, 71% exhibited induction of angiogenesis, and 39% had tumors that were positive for blood vessel invasion. With a median follow-up time of 3.5 years (range, 8 to 145+ months), the overall projected 5-year survival was 29% and the median disease-free interval was 23 months. Results of univariate and multivariate analysis of survival and the disease-free interval identified the degree of angiogenesis (density less than 1 versus more than 1 and number of neovessels less than 6 versus more than 6) as the only independent and significant predictors of the disease-free interval. Patients whose tumor showed a density of angiogenesis of 1 or greater and a number of neovessels of 6 or greater faced a significantly (p = 0.0001) higher relative risk of suffering systemic recurrence of their primary tumor than did their low-risk counterparts. Results demonstrate that angiogenesis significantly correlates with late treatment failure (metastasis), and this is acquired at a critical density and number of vessels.

Expression of proliferating cell nuclear antigen (PC10), p53 protein and c-erbB-2 in renal adenocarcinoma

Expressions of proliferating cell nuclear antigen (PC10), p53 protein (CMI) and c-erbB-2 (NCL-1) were immunohistochemically analysed in 123 renal adenocarcinomas with known follow-up data. c-erbB-2 protein was weakly and focally expressed in 10% of the tumours, and the expression was not related to clinical or histological variables or survival. p53 protein was expressed in 33% of the tumours. Expression of p53 protein was independent of stage, grade and prognosis, while expressions of c-erbB-2 and p53 were weakly interrelated. Proliferating cell nuclear antigen was expressed in all tumours, and the fraction of PC10-positive nuclei was significantly related to grade, stage and prognosis. Multivariate analysis of clinical, histological and immunohistochemical prognostic factors indicated that the extent of the tumour, its histological differentiation and proliferation rate of the cancer cells are the most important prognostic factors. Recurrence-free survival was related to the fraction of PC10-positive nuclei, histological differentiation, sex and expression of p53 protein. Over-expression of p53 protein was related to a long recurrence-free survival. Our results show that PC10 immunolabelling can be used to determine the prognostic category in renal adenocarcinoma, whereas the expressions of p53 protein or c-erbB-2 are only weak prognostic indicators.

Prognostic significance of serum CA 125 antigen assay in patients with non-small cell lung cancer

BACKGROUND

The serum levels of CA 125 tumor-associated antigen in patients with lung cancer have been previously related to TNM stage, histologic type, and survival rate. In the current study, the prognostic information provided by the CA 125 antigen assay was analyzed.

METHODS

Preoperative serum of CA 125 antigen was determined in 137 patients with non-small cell lung cancer. The assay was performed by means of a solid-phase enzyme-immunoassay test. The influence of CA 125 serum level on postoperative outcome was studied by a multivariate analysis, performed with Cox's proportional hazards regression model.

RESULTS

Patients whose initial CA 125 level was higher than 15 U/ml had a 3.25-fold greater likelihood of relapse (95% confidence interval [CI], 1.7-6.21) (P < 0.001) and a 4.27-fold greater likelihood of deaths (95% CI, 2.42-7.55) (P < 0.001) due to cancer than patients with lower values. For patients with serum levels over 15 U/ml, the 36-month survival rate posttreatment was lower (67% versus 20%) (P < 0.001), as was the disease-free rate (64% versus 13%) (P < 0.001). After adjustment for TNM stages, histologic type, sex, and age, patients with CA 125 values over 15 U/ml continued exhibiting higher risk of relapse (hazard ratio, 2.2; 95% CI, 1.04-4.69) (P = 0.04) and higher risk of death (hazard ratio, 2.42; 95% CI, 1.29-4.54) (P = 0.006).

CONCLUSIONS

CA 125 is an independent prognostic factor of survival and tumor relapse in non-small cell lung cancer. The preoperative serum level of CA 125 antigen is inversely correlated with the outcome figures. The authors suggest that CA 125 be included in any future multifactorial analysis of survival.

Blood vessel invasion and expression of sialyl Lewisx and proliferating cell nuclear antigen in stage I non-small cell lung cancer. Relation to postoperative recurrence

BACKGROUND

Recurrence in Stage I non-small cell lung cancer was examined with respect to vascular invasion and the immunohistochemical expression of sialyl-dimeric Lewisx (SLX) and proliferating cell nuclear antigen (PCNA).

METHODS

One hundred twenty-eight patients with Stage I non-small cell lung cancer who had a curative resection were the subjects of this study. Using tumor tissues fixed in formaldehyde solution, blood vessel invasion (BVI) and lymphatic invasion stained with Victoria blue-hematoxylin and eosin and the immunohistochemical expression of SLX and PCNA were retrospectively studied with respect to postoperative recurrence.

RESULTS

By univariate analysis, BVI and SLX and PCNA expression were significantly important factors of disease-free survival (P < 0.01). The disease-free survival of the patients with both BVI and SLX expression was significantly shorter than that of the patients with BVI but negative SLX expression (P < 0.02). In 35 patients with recurrence, tumors with PCNA expression showed a significantly shorter time to recurrence compared with tumors without PCNA expression (P < 0.01).

CONCLUSIONS

BVI and SLX expression may be important determinants of recurrence. PCNA may be a determinant of time to recurrence.

Comparative flow cytometric analysis of proliferating cell nuclear antigen (PCNA) antibodies in human solid neoplasms

Proliferating cell nuclear antigen (PCNA), an auxiliary protein of DNA polymerase delta, associated with DNA synthesis, is increasingly used to determine tumor growth rate. To determine the growth fraction by PCNA, various antibodies and fixation procedures are being used. We assessed the flow-cytometric measurement of PCNA using three monoclonal antibodies (PC10, 19F4, and 19A2) and two fixation protocols (paraformaldehyde and methanol) in tissue-culture cell lines and human solid neoplasms to determine their potential clinical application. Thirty-one solid tumors and four normal tissues were analyzed, along with MOLT-4 and HL-60 cell lines as positive controls and normal peripheral blood lymphocytes as a negative control. PC10 with methanol fixation consistently detected higher PCNA positivity in human solid neoplasms than 19F4 and 19A2. Using PC10, the differences in positivity among fixation methods occurred in the G0/1 phase, not in S + G2M, of the cell cycle. No correlation was found between PCNA positivity and tumor grade and DNA ploidy in tumors analyzed. A statistical correlation was found between overall PCNA positivity and RNA content as determined by acridine orange analysis. The growth fraction by PCNA in solid neoplasms was most reliably determined by PC10 with methanol fixation.

p53 expression in oat and non-oat small cell lung carcinomas: correlations with proliferating cell nuclear antigen

AIMS

To investigate the immunohistochemical expression of p53 protein in small cell lung carcinoma (SCLC), comparing it with that in non-small cell carcinoma (NSCLC); and to evaluate the correlation between p53 and proliferating cell nuclear antigen (PCNA) expression as well as between p53 and PCNA expression and survival.

METHODS

Paraffin wax embedded tissues from 61 cases of primary lung carcinoma were stained for p53 protein and PCNA using the monoclonal antibodies 1801 and PC-10, respectively, in a standard avidin-biotin immunoperoxidase method.

RESULTS

Of the 61 lung carcinomas 35 (57%) were positive for p53 (range 1% to 90%). Ninety percent of the non-oat SCLC contained positive cells and the labelling index (LI) was significantly higher than that of the oat SCLC (p < 0.001). SLCC also displayed a higher p53 LI than NSCLC (p < 0.01); no difference was found between squamous carcinoma, adenocarcinoma, and oat cell carcinoma. A p53 LI of greater than 1% tended to be associated with nodal metastases (p < 0.05), and p53 expression in node positive tumours as well as in oat cell carcinomas was indicative of poorer survival (p < 0.01 and p < 0.1, respectively). A p53 Li of greater than 60% was a negative prognostic factor in non-oat SCLC (p < 0.05). PCNA LI was highest in non-oat SCLC and lowest in NSCLC; oat cell carcinomas had a mean LI intermediate between NSCLC and non-oat SCLC (NSCLC v oat cell carcinoma p < 0.05 and oat cell v non-oat cell carcinomas p < 0.01). A PCNA LI was not correlated with nodal metastases or survival, but there was a significant positive correlation between PCNA LI and p53 LI (rs = 0.484, p < 0.001).

CONCLUSIONS

p53 and PCNA expression differ substantially among the various types of lung carcinomas. Substantial differences were also found between oat and non-oat types of SCLC, indicating that SCLC is heterogeneous as far as proliferation rate and altered p53 expression is concerned. p53 seems to be of some prognostic value. The relation between PCNA and p53 expression indicates that the PCNA gene is slightly upregulated by p53.