Proliferating cell nuclear antigen (PCNA) expression as a prognostic indicator for renal cell carcinoma: comparison with tumour grade, mitotic index, and silver-staining nucleolar organizer region numbers

Diminazene aceturate-induced cytotoxicity is associated with the deregulation of cell cycle signaling and downregulation of oncogenes Furin, c-MYC, and FOXM1 in human cervical carcinoma Hela cells

Diminazene aceturate (DIZE) is an FDA-listed small molecule known for the treatment of African sleeping sickness. In vivo studies showed that DIZE may be beneficial for a range of human ailments. However, there is very limited information on the effects of DIZE on human cancer cells. The current study aimed to investigate the cytotoxic responses of DIZE, using the human carcinoma Hela cell line. WST-1 cell proliferation assay showed that DIZE inhibited the viability of Hela cells in a dose-dependent manner and the observed response was associated with the downregulation of Ki67 and PCNA cell proliferation markers. DIZE-treated cells stained with acridine orange-ethidium and JC-10 dye revealed cell death and loss of mitochondrial membrane potential (Ψm), compared with DMSO (vehicle) control, respectively. Cellular immunofluorescence staining of DIZE-treated cells showed upregulation of caspase 3 activities. DIZE-treated cells showed downregulation of mRNA for G1/S genes CCNA2 and CDC25A, S-phase genes MCM3 and PLK4, and G2/S phase transition/mitosis genes Aurka and PLK1. These effects were associated with decreased mRNA expression of Furin, c-Myc, and FOXM1 oncogenes. These results suggested that DIZE may be considered for its effects on other cancer types. To the best of our knowledge, this is the first study to evaluate the effect of DIZE on human cervical cancer cells.

Metanephric Adenoma of the Kidney with Massive Hemorrhage and Necrosis: Immunohistochemical, Ultrastructural, and Flow Cytometric Studies

Metanephric adenoma of the kidney is rare. We report 2 cases of metanephric adenoma with massive hemorrhage and necrosis. Case 1, a 42-year-old Japanese woman, complained of abdominal pain. Case 2, a 41-year-old Japanese woman, complained of fever and lumbago. They underwent nephrectomy. The cut surface was solid and yellow with massive hemorrhage and necrosis. These tumors showed packed tubular and glomeruloid patterns. The tumor cells were uniform and small, with uniform, oval, and hyperchromatic nuclei and scant cytoplasm, and showed reactivity for cytokeratin, vimentin, and CD 57. The MIB-1 indexes were up to 0.63%. The DNA ploidy pattern was diploid. The tumor cells formed small tubular structures with lumina and microvilli. These features suggested that metanephric adenoma is a benign tumor of an immature epithelial nature.

p53 Protein and Proliferating Cell Nuclear Antigen (PCNA) Expression in Small Round Cell Tumors of Bone and Adjacent Soft Tissue

Sixty small cell tumors of bone and adjacent soft tissue were studied in an attempt to define the incidence of immunohistochemically detectable p53 protein and cor relate these findings with the results of proliferating cell nuclear antigen (PCNA) immunohistochemical staining and mitotic counts. All of the lesions had been for malin-fixed and paraffin-embedded; half were subjected to decalcification prior to processing. The study population included 12 Ewing's sarcomas of bone, 3 atypical Ewing's sarcomas of bone, 3 primitive neuroectodermal tumors of bone, 11 Askin tumors of the thoracopulmonary region, 11 small cell osteosarcomas of bone, 10 mesenchymal chondrosarcomas of bone, and 10 malignant lymphomas involving bone. The patients ranged in age at the time of presentation from 17 to 67 years. Overall, the incidence of p53 positivity was extremely low in these lesions, irre spective of tumor type. Positive nuclear staining with an antibody to p53 was found in none of the 12 Ewing's sarcomas, none of the 3 atypical Ewing's sarcomas, none of the 3 primitive neuroectodermal tumors of bone, 1 of the 11 Askin tumors of the thoracopulmonary region (1.5% of tumor cells positive), 1 of the 11 small cell osteosarcomas (2% of tumor cells positive), 1 of the 10 mesenchymal chondrosar comas of bone (7% of tumor cells positive), and 2 of the 10 malignant lymphomas involving bone (0.5% and 1% of tumor cells positive, respectively). The majority of tumors showed PCNA positivity within the tumor cells, although the incidence of PCNA positivity within the histologic types varied greatly; in general, the higher PCNA counts corresponded to higher mitotic counts within the individual lesions. The present study did not demonstrate any correlation between mutant p53 accu mulation detected by immunohistochemistry and tumor type, and so it is unlikely that p53 positivity will prove to be of great use in the differential diagnosis of these lesions. A correlation between p53 positivity and PCNA staining or mitotic activity was not apparent. Int J Surg Pathol 2(4):259-268, 1995

Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies

Recent advancements in the molecular characterization of renal cell carcinoma altered the classification system and now kidney cancer is divided into several distinct histologic subtypes. Although once a separate histologic category, sarcomatoid renal cell carcinoma is no longer considered a separate tumor type because it can occur with all histologic subtypes. Limited research on tumors with sarcomatoid change has led to minimal progress in the understanding and treatment of these tumors. Because the sarcomatoid variant of renal cell carcinoma can account for approximately one in six cases of advanced kidney cancer, we hope to familiarize clinicians with these tumors by describing the historic background, histologic features, molecular characterization, diagnosis, prognosis, treatment strategies, and active clinical trials of this aggressive type of tumor.

VEGF, COX-2, and PCNA expression in renal cell carcinoma subtypes and their prognostic value

OBJECTIVE

To evaluate the prognostic value of new markers such as VEGF (vascular endothelial growth factor), COX-2 (cyclooxygenase-2), and PCNA (proliferating cell nuclear antigen) and review their differences in expression by histological subtype in patients with renal cell carcinoma (RCC).

METHODS

About 99 patients who underwent radical (n = 79) or partial nephrectomy (n = 20) were included in this study. Histopathological specimens from the subjects were retrospectively analyzed immunohistochemically for the presence of VEGF, COX-2, or PCNA.

RESULTS

Mean staining ratios for VEGF, COX-2, and PCNA were 16.5, 16.8, and 31%, respectively. Correlations were evaluated among these three prognostic factors. There was no correlation between PCNA and VEGF (P = .068), but there were significant correlations between COX-2 and both PCNA and VEGF (P = .005 and P = .000, respectively). A significant correlation was found between the expression of VEGF and both pathologic stage and vascular invasion (P = .018 and P = .025, respectively). In addition, patients with conventional RCC had significantly lower VEGF and COX-2 levels than those with papillary RCC (P < .012).

CONCLUSIONS

It is obvious that prognostic factors such as VEGF, COX-2, and PCNA may vary depending on histological subtype. The level of expression of these factors together with histological subtype may provide valuable predictive information about the outcome of treatment.

Costimulatory B7-H1 in renal cell carcinoma patients: Indicator of tumor aggressiveness and potential therapeutic target

Expression of B7-H1, a costimulating glycoprotein in the B7 family, is normally restricted to macrophage-lineage cells, providing a potential costimulatory signal source for regulation of T cell activation. In contrast, aberrant expression of B7-H1 by tumor cells has been implicated in impairment of T cell function and survival, resulting in defective host antitumoral immunity. The relationship between tumor-associated B7-H1 and clinical cancer progression is unknown. Herein, we report B7-H1 expression by both renal cell carcinoma (RCC) tumors of the kidney and RCC tumor-infiltrating lymphocytes. In addition, our analysis of 196 clinical specimens reveals that patients harboring high intratumoral expression levels of B7-H1, contributed by tumor cells alone, lymphocytes alone, or tumor and/or lymphocytes combined, exhibit aggressive tumors and are at markedly increased risk of death from RCC. In fact, patients with high tumor and/or lymphocyte B7-H1 levels are 4.5 times more likely to die from their cancer than patients exhibiting low levels of B7-H1 expression (risk ratio 4.53; 95% confidence interval 1.94-10.56; P < 0.001.) Thus, our study suggests a previously undescribed mechanism whereby RCC may impair host immunity to foster tumor progression. B7-H1 may prove useful as a prognostic variable for RCC patients both pre- and posttreatment. In addition, B7-H1 may represent a promising target to facilitate more favorable responses in patients who require immunotherapy for treatment of advanced RCC.

Renal cell carcinoma: new prognostic factors?

PURPOSE OF REVIEW

There are limited independent predictors of survival in patients with renal cell carcinoma. Factors related to the tumor, host and treatment may help us to predict prognosis to a certain extent. Prognostic indicators would enable selection of patients who can benefit from adjuvant therapy and thus should be enrolled in clinical trials. This review highlights developments in the identification of current prognosticators for patients with renal cell carcinoma.

RECENT FINDINGS

Tumor stage, grade and patient-performance status are the known prognostic indicators in renal cell carcinoma. Besides these parameters, many molecular and cytogenetic markers were evaluated recently. Unfortunately, none of these parameters appear to be a better predictive prognostic factor than the usual staging and grading. Therefore, efforts to identify new markers for tumor proliferation and progression are still ongoing. It was recently reported that low carbonic anhydrase 9 staining may be an independent poor prognostic factor in patients with renal cell carcinoma. Moreover, there is increasing interest in prognostic indices and predictive algorithms for survival. Staging systems that combine the pathological features with additional prognostic variables have been constructed to predict outcome. The UCLA Integrated Staging System seems to be superior to staging alone in differentiating patients' survival.

SUMMARY

Although the literature reviewed contains numerous promising clinical, histological, molecular and cytogenetic parameters, none of them has yet been shown to have an independent prognostic value

Prognostic factors of renal cell carcinoma

PURPOSE

Determination of prognostic factors is essential for the management of renal cell carcinoma. Stage, histological grade and type, and performance status are now well known and commonly used. During the last decade numerous predictors of patient outcome were tested. This review summarizes the most important studies, explores and compares the results, and tries to respond to the question, "Today, what do we expect of clinical, molecular and genetic factors concerning survival of patients with renal cell carcinoma?"

MATERIALS AND METHODS

Based on MEDLINE literature searches we comprehensively reviewed the literature on the prognostic factors associated with the tumor, the patient and the treatment.

RESULTS

During the last decades numerous factors have been studied but few of them maintained independent significance in terms of overall survival as assessed by multivariate analysis. Results are more often controversial from one series to another. No known molecular or cytogenetic tumor marker has been identified to help diagnose, manage or confirm renal cell carcinoma remission, progression or relapse.

CONCLUSIONS

The classical prognostic factors remain histological grade, histological type, performance status, patient age, number and location(s) of metastatic sites, time to appearance of metastases and prior nephrectomy. The only striking advancement during the last few years has been the proven contribution of radical nephrectomy for metastatic disease in patients with good performance status.

Proliferative activity of renal cell carcinoma associated with acquired cystic disease of the kidney: comparison with typical renal cell carcinoma

To assess the proliferative activity of renal cell carcinoma (RCC-A) in patients with acquired cystic disease of the kidney (ACDK) after long-term hemodialysis, we analyzed cell cycle, DNA ploidy, and S-phase fraction by flow cytometry (FCM) and proliferating cell nuclear antigen (PCNA) labeling index by immunohistochemistry. The data were compared with those of typical RCC (tRCC). Sixteen (88.9%) of 18 RCC-As showed a diploid pattern. The values of cells at each phase in the cell cycle in RCC-A group (S, 4.36% + 2.16%; G2M, 5.06% + 1.90%; S+G2M, 9.41% + 2.81%; P <.05) were significantly different from those of tRCCs (S, 8.91% + 6.58%; G2M, 8.77% + 5.73%; S+G2M; 17.67% + 7.61%). The PCNA labeling index was statistically significantly lower in the RCC-As (24.01% +/- 13.4%; P <.05) than in tRCCs (42.27% +/- 26.1%). These results indicate that the RCC-As are less proliferative than tRCC and are consistent with the observation that RCC-As are less aggressive neoplasms.

Proliferating cell nuclear antigen and epidermal growth factor receptor (EGFr) status in renal cell carcinoma patients with polysomy of chromosome 7

We investigated 40 cases of renal cell carcinoma (RCC) to study the polysomy 7 status in papillary and clear-cell types (nonpapillary RCC) and relationship with clinical, pathological, and biological features such as grade, stage, tumor proliferation rate (PCNA expression) and epidermal growth factor receptor (EGFr) expression and thereby to understand the prognostic significance of polysomy 7 and EGFr expression. In a prospective study, chromosome 7 copy number was analyzed in tumor cells by using fluorescence in situ hybridization (FISH) with an alpha-satellite DNA probe for chromosome 7. Both proliferating cell nuclear antigen (PCNA) and EGFr expression were examined in paraffin sections by immunostaining. The relationship between clinicopathological and clinicobiological parameters was evaluated by appropriate statistical methods. Polysomy 7 was present in 100% of papillary and 56.2% of clear-cell types RCC. In clear-cell RCC, in comparison with polysomy 7-dominant (D) category (20-50% polysomy-7 cells), polysomy 7-major (M) category (>50% polysomy 7 cells) was associated with higher tumor grade (P = 0.05). Polysomy 7 was also correlated with stage of the disease (P = 0.006). The PCNA index ranged between 12.8-89.6% and was comparatively high in high-grade tumors (P = 0.001). The PCNA index was also correlated with polysomy 7 (P = 0.002), and the association was stronger in tumors with polysomy M versus polysomy D category (P = 0.02). The EGFr expression did not correlate with either grade, stage, PCNA, or polysomy 7. The correlation of polysomy 7 with less favorable prognostic factors such as higher tumor grade, stage, and higher proliferative index in the present study indicates that polysomy 7 might be used as a prognostic predictor in clear-cell RCC. Evaluation of clinical end points will confirm the prognostic potential of the genetic marker polysomy 7 in our study.

The histology and growth kinetics of canine renal oncocytoma

A renal oncocytoma was diagnosed in a 10-year-old English springer spaniel with a 5-month history of anorexia, vomiting and weight loss. The tumour, which was localized to the kidney, was treated by simple nephrectomy and the dog made a full recovery. Histologically, the tumour consisted of cells with abundant eosinophilic cytoplasm forming acini and alveolar nests set within a loose fibrovascular stroma. The results of cell kinetic studies (AgNOR score 2.68, PCNA index 5.2%) were comparable with findings reported for benign human renal tumours. This appears to be the first reported case of renal oncocytoma in a dog.

Biomarkers of renal cell carcinoma. Past and future considerations

Renal cancer includes several distinct entities with a range of biologic and clinical behaviors from relatively indolent to extremely aggressive tumors. Although conventional prognostic factors such as stage and grade are quite useful, other clinical, laboratory, and pathologic findings are now believed to have additional predictive values. This article reviews the literature on the potential utility of biomarkers in renal cell carcinoma. To date, only a few biomarkers, such as Ki-67, appeared to be potentially useful for monitoring renal cancer patients. New biomarkers including MN/CA9 and circulating cell detection require further and extensive studies to assess their potential clinical utility.

Improving accuracy in the grading of renal cell carcinoma by combining the quantitative description of chromatin pattern with the quantitative determination of cell kinetic parameters

The determination of grade and stage in renal cell carcinomas (RCCs) often fails to predict the actual clinical outcome for individual patients. The aim of the present work was to investigate whether it is possible to significantly improve the prognostic accuracy of the grading system by using the combination of two independent computer-assisted microscopy techniques. The first technique relates to the quantitative description of morphonuclear and nuclear DNA content features by means of the image analysis of Feulgen-stained cell nuclei, and the second quantitatively characterizes tumor growth by means of different cell kinetic parameters. These parameters consist of a duplication of a time-related parameter determined by means of the technique of using silver-stained proteins in interphase nucleolar organizer regions (AgNOR), a proliferation index determined by means of MIB-1 immunohistochemistry, and an apoptotic index determined by means of the terminal dUTP nick end labeling technique. The prognostic value of these quantitative features was investigated in a series of 60 RCCs. The quantitative analysis of Feulgen-stained nuclei made it possible to identify subgroups of patients with significantly different prognoses in both grade II and grade III RCCs. We labeled the RCCs associated with the most favorable prognoses as grade II- and III- and those with the least favorable ones as grade II+ and III+. The two most important kinetic variables to identify patients with different clinical outcomes were the MIB-1 index and the mean AgNOR area in the MIB-1-positive cells. Three significantly different survival curves were obtained for the 53 grade II and III RCC patients. Our results show that conventional RCC grading can be significantly improved by the quantitative analysis of Feulgen-stained nuclei, by cell kinetic parameter determination, and, more importantly, by combining the proliferation index with the mean AgNOR area parameter.

Renal cell carcinoma with massive osseous metaplasia and bone marrow elements

Focal calcifications are frequently seen in renal masses and may be present in renal cell carcinomas. Metaplastic bone formation, on the other hand, is a rare event. We report a unique case of a large calcified renal cell carcinoma with massive osseous metaplasia and bone marrow elements. The clinical and pathologic differential diagnosis for this tumor is discussed along with a review of the literature on this unusual phenomenon.

Risk and prognosis in renal neoplasms. A pathologist's prospective

The incidence of renal carcinoma has increased in the United States over the last two decades. An increased rate of detection of incidental tumors and a variety of exogenous risk factors may be responsible for this increase. Pathologic stage and nuclear grade remain the most important and practical prognostic features, however, the specific tumor type has emerged as important as the cytogenetic validation of recent renal carcinoma classification. Proliferation markers, DNA ploidy, and morphometry have powerful predictive value but are handicapped by cost and complexity. The search continues for molecules of diagnostic and prognostic utility that may also impact invasive and metastatic capability for this group of neoplasms whose course is principally determined by the completeness of the original resection.

Sarcomatoid renal carcinoma: the final common dedifferentiation pathway of renal epithelial malignancies

Sarcomatoid renal carcinoma (SRC) is an aggressive neoplasm with an age and gender distribution similar to that of conventional (clear cell) renal cell carcinoma (RCC). Genetic and morphologic evidence indicates that the tumor results from de-differentiation of renal epithelial malignancy and associations with RCC, papillary renal carcinoma, chromophobe renal carcinoma and collecting duct carcinoma have been reported. The tumor is composed of sheets of malignant spindle cells that have immunohistochemical and ultrastructural features of both stromal and epithelial cells, and may contain myxoid areas containing osteoclast-like giant cells or pleomorphic sarcomatoid spindle cells resembling rhabdomyoblasts. Rare cases of osteogenic SRC have been described. The tumor shows marked proliferative activity in growth kinetic studies and is usually associated with a poor patient survival that is best predicted by staging.

Ki-67 index as indicator of the post-surgical prognosis in feline mammary carcinomas

Forty-eight feline mammary carcinomas (FMC) were resected surgically from 48 cats to determine whether the Ki-67 index (Ki-67I) would provide an indication of the post-surgical survival time (PST). Twenty-four cats (50 per cent) were still alive (group A) one year after surgery, whilst 24 (50 per cent) (group B) had died. Formalin-fixed, paraffin wax-embedded histological sections were immunostained with a monoclonal antibody to Ki-67 (MIB-1) and at least 1000 nuclei in eight to 10 representative fields were counted. The Ki-67I was expressed as the percentage of positive nuclei. In FMC, the Ki-67I ranged from 7.5 to 49.7 (24.8+/-9.5). A statistically significant difference (P = 0.000006) in the Ki-67I was found between group A and group B cats. No other statistically significant differences were found between these groups. The Ki-67I did not correlate with age or different histological type, according to the WHO classification. A Ki-67I cut-off of 25.2 represents a useful tool for identifying FMC with a more aggressive course.

Bax expression has prognostic significance that is enhanced when combined with AgNOR counts in glottic carcinomas

Using nucleolar organizer regions (NORs) as a proliferative marker and Bax expression as a marker for apoptosis, we have studied the individual and combined prognostic significance of these markers. Successive sections of diagnostic, formalin-fixed and paraffin-embedded specimens from 69 patients with T1-4 tumours were stained with a rabbit anti-human Bax polyclonal antibody and silver nitrate for visualization of NORs (AgNORs). After classification for staining intensity and the percentage of Bax expression, a final score resulting in four classes of increasing Bax expression was obtained. AgNOR counts were expressed as mean counts (mAgNOR) and the percentage of tumour nuclei with more than one AgNOR (pAgNOR>1). Both AgNOR parameters were grouped in three classes with increasing values. Low Bax scores correlated significantly with poor prognosis (P = 0.0106). For mAgNOR and pAgNOR>1, high values correlated with poor prognosis (P = 0.0185 and P = 0.0003 respectively). A combined parameter, for which the Bax score was subtracted from the AgNOR scores, appeared to be statistically stronger than the individual parameters (P < 0.0001). Both Bax expression and AgNOR scores, and in particular the combination of these parameters, appear to be strong prognostic markers in glottic squamous cell carcinomas.

The value of PCNA and AgNOR staining in endoscopic biopsies of gastric mucosa

The aim of the present study was to examine the usefulness of the quantification of PC10-positive-cells and of Argyrophilic Nucleolar Organizer Regions (AgNORs) in gastric biopsies for the identification of gastric mucosal proliferative lesions. Fifty seven paraffin-embedded endoscopic biopsies were classified into four histologic groups: normal, inflammatory, dysplastic and neoplastic mucosa. The percentage of PC10-positive cells was determined by immunohistochemistry. The AgNOR parameters determined included the total number of all identifiable silver precipitations in the nucleus, the mean number of silver precipitations per cluster, and the presence of morphologically heterogenous silver precipitations. Group comparisons were performed using the Kruskall Wallis and Dunn non-parametric tests with a significance level of 5%. A discriminant analysis (followed by the jack-knife procedure) was performed using the three AgNOR parameters plus the percentage of PCNA-positive cells as the independent variables and histological groups as the dependent variable. All three AgNOR parameters, as well as the percentage of PCNA-stained nuclei, showed their highest values in the carcinoma group. However, no good differentiation among the four histologic groups was obtained using only one of these parameters, since there was always considerable overlap among them. By combining all the parameters in a linear discriminant analysis, we obtained a correct classification in 48 out of 57 cases. Within the classification errors there was only one false positive carcinoma, which was in fact a dysplasia and only one false negative carcinoma erroneously classified as dysplasia. The number of cells with heterogenous AgNORs was the most important parameter for the discriminant analysis. No correlation between PCNA values and the AgNOR parameters could be found, thus indicating that they do not represent the same phenomenon in the cell cycle. We concluded that the use of a combination of various proliferation parameters in a linear discriminant analysis may be helpful for differentiating gastric mucosal lesions. The peculiar AgNOR morphology is an important variable which should be taken in consideration in quantitative studies. PCNA and AgNORs seem to represent different physiological phenomena in the cell cycle.

Assessment of proliferating cell nuclear antigen expression and prognosis in patients with renal cell carcinoma with pulmonary metastases

BACKGROUND

The presence of proliferating cell nuclear antigen (PCNA) has been suggested as a more important prognostic marker than either grade or mitotic index in the prognosis of patients with renal cell carcinoma. We assessed the immunoreactivity of PCNA in primary lesions and pulmonary metastases from patients with renal cell carcinoma and correlated the results with various histopathologic features and prognostic factors.

METHODS

We studied the relationship between PCNA expression and clinical prognostic factors from resected primary lesions and pulmonary metastases from 10 patients and primary lesions from 32 patients with renal cell carcinoma without metastases. The cells were immunohistochemically stained with PCNA monoclonal antibody (PC-10) and 1000 nuclei were counted. The results were expressed as a ratio of stained to total cells (PCNA labeling index, LI %).

RESULTS

The PCNA LI of pulmonary metastatic nuclei was significantly higher than the PCNA LI of renal lesions either from patients with (P < 0.05) or without (P < 0.01) metastases. Also, the mean PCNA LI of the pulmonary lesions in patients dying within 3 years of diagnosis was higher than the mean PCNA LI of patients surviving greater than 3 years.

CONCLUSION

Our findings suggest that the PCNA LI, which was determined by immunohistochemical analysis, is an important marker reflecting the biologic behavior of renal cell carcinomas. The degree of PCNA expression in this study was of prognostic significance.

Prognostic factors of renal cell carcinoma: a multivariate analysis

BACKGROUND AND OBJECTIVES

To establish appropriate therapeutic modalities for renal cell carcinoma (RCC), informations on the factors affecting prognosis of patients are essential. For this purpose, multivariate analysis including a large set of variables is necessary.

METHODS

Prognostic significance of 14 clinical factors and 19 histologic factors including counting of silver-stained nucleolar organizer regions (AgNORs) were evaluated in 96 patients. Age of patients ranged from 41 to 85 (median 59) yr with a male to female ratio of 4:1. The tumors were staged based on the TNM classification as follows: 7 in stage I, 58 in stage II, 15 in stage III, and 11 in stage IV.

RESULTS

The overall and metastasis-free survival rates in all patients were 80.1% and 72.7%, respectively. Multivariate analysis using Cox's proportional hazards model performed on the factors proved to be significant at the univariate analysis. Univariate analysis revealed four clinical factors including presence of macroscopic hematuria, symptoms such as pain and palpable abdominal mass, anemia, and adjuvant therapy, and nine histologic factors, including AgNOR count, to be significant for survival. Multivariate analysis showed that anemia, pathological stage, and AgNOR count were independent factors for overall survival of patients. The AgNOR count, in particular, is the only predictive factor for metastasis-free survival.

CONCLUSIONS

Among various clinicopathological factors, anemia, pathological stage, and AgNOR count are significant prognosticators of RCC. The AgNOR count is also predictive factor for metastasis-free survival.

Rapid and prognostically valid quantification of immunohistochemical reactions by immunohistometry of the most positive tumour focus. A prospective follow-up study on breast cancer using antibodies against MIB-1, PCNA, ER, and PR

The prognostic significance of immunohistochemical markers for cell proliferation [MIB-1, proliferating cell nuclear antigen (PCNA)] and hormone receptor analysis [oestrogen receptor (ER), progesterone receptor (PR)] was tested by means of immunohistometry in a series of 103 breast cancer patients in comparison with the lymph node status N, the tumour size T, histomorphological grading, and the biochemical ER and PR status. Immunohistochemical reactions were performed on 2 microns sections from paraffin-embedded tissue, using an indirect peroxidase method. The proportion of immunostained tumour cell nuclei was determined using a TV-image analysis system. Measurements were performed using a 20 x objective on 40 viewing fields (1.94 mm2, MIB-1 and PCNA) or 20 viewing fields (0.97 mm2, ER and PR). The mean immunopositivity of all viewing fields and the value of the most immunopositive viewing field (MIB-1max, PCNAmax, PRmax, ERmax) were calculated. The mean values and the maximal values were highly correlated (r = 0.903, P < 0.001). After 1:2:1 quantilization, 84.2 per cent of the 412 single measurements revealed mean and maximal values in the same category (P < 0.0001). For each of the four immunohistochemical markers, the prognostic significance of the maximal values was higher than that of the mean values. The highest prognostic significance was found for MIC-1max (P = 0.0002), followed by PRmax (P = 0.0046), ERmax (P = 0.0154), and PCNAmax (P = 0.0161). From the results of a Cox model, a 'prognostic index (PI)' was developed, ranging from -1 to 8: PI = 2 x N + T + MIB-1max-PRmax. The four groups of patients with PI values of < 2, 2-3, 4-5, and > 5 revealed significantly different 7.5-year survival probabilities (P < 0.0001). The simplicity of the PI makes it a clinically useful, routinely applicable, and understandable parameter in the surgical pathology of breast carcinoma.

Argyrophilic nucleolar organiser regions (AgNORs) count as indicator of post-surgical prognosis in feline mammary carcinomas

Feline mammary carcinomas (FMC) were surgically resected from 51 cats to verify that the nucleolar organiser regions (AgNORs) count is related to the post-surgical survival time (PST). After one year post-surgery, 27 cats (group A) were still alive (52.9 per cent) while (41.7 per cent) (group B) had died as a consequence of FMC. Formalin-fixed, paraffin wax-embedded histological sections were stained with silver nitrate and the AgNORs were then counted at x 100 oil immersion objective. In FMC AgNORs count ranged from 1.2 to 12.1 (6.10+/-2.3). A statistically significant difference (P=0.000112) in the AgNORs count was found between cats from group A and group B. No other statistically significant differences were found between group A and B. AgNORs count was not correlated to age or different histological type, according to the WHO classification. Using this technique it is possible to identify two populations of FMC with a statistically significant difference in the PST.

Proliferative activity in peripheral ossifying fibroma and ossifying fibroma

A proliferative activity study analysing morphometric and quantitative aspects of nucleolar organizer regions (NORs) and proliferating cell nuclear antigen (PCNA) expression was conducted in 10 cases of peripheral ossifying fibroma (POF) and 10 cases of ossifying fibroma (OF). For NOR identification, the silver staining technique (AgNOR technique) was used. PCNA expression was determined by immunohistochemical staining using the PC10 antibody. The AgNOR analysis for the two lesions showed a profile characteristic of benign lesions. OF showed higher AgNOR number and PCNA expression than POF. Our results suggest increased proliferative activity in OF compared with POF.

Epidermal growth factor receptor expression is associated with rapid tumor cell proliferation in renal cell carcinoma

Epidermal growth factor receptor (EGF-r) expression and tumor cell proliferation rate have been proposed as potential prognostic parameters in renal cell carcinoma (RCC). In this study, immunohistochemical stains using antibodies to EGF-r and the cell proliferation marker Ki-67 (MIB-1) were used to study the relationship between EGF-r expression, tumor cell proliferation, and prognosis in 50 non-papillary RCC extending beyond the renal capsule (pT3). A high Ki-67 labeling index (LI) was associated with poor patient prognosis (P < .05). Thirty-eight cases (76%) expressed strong cell membrane immunoreactivity for EGF-r. There was a tendency toward a shortened survival for EGF-r-positive tumors (P = .08). Tumor growth fraction (Ki-67 LI) was significantly higher in EGF-r-positive tumors than in EGF-r-negative tumors (P < .05), suggesting that rapid tumor proliferation might be responsible for the poor prognosis associated with EGF-r-positive RCC.

Renal cell carcinoma: Pathological prognostic criteria

– Pathological criteria so far employed in the prognosis of renal cell carcinoma provide no clinically useful information. This paper emphasises the possibilities offered by histopathology today for tackling this clinical problem more effectively. Nuclear analysis, with objective and quantitative evaluation of the degree of distortion, may provide extremely useful information. The authors correctly classified 90% of the 50 cases of renal cell carcinoma considered and whose follow-up at 5 years was known.

Flow cytometry in renal cell carcinoma

– The most important prognostic factors in renal carcinoma are the stage and grade. World literature is full of information on new markers, the analysis of DNA with the cytofluorimetric method being foremost, as it allows the cell lines in the neoplasm to be assessed and at the same time the ploidy and cell cycle stages to be studied. We have found an excellent correlation between the ploidy and cell grade. After a preliminary study we can conclude that the method is easy to perform and to reproduce. The procedure is also interesting for retrospective studies which allow the pathologist to select the blocks to be examined, thereby avoiding those widely contaminated by hemorrhages or necrosis.

p53 protein expression but not mdm-2 protein expression is associated with rapid tumor cell proliferation and prognosis in renal cell carcinoma

The clinical course of renal cell carcinoma (RCC) is highly variable. Overexpression of the p53 protein has been suggested as a possible prognostic parameter in RCC. Overexpression of the mdm-2 oncogene product has been shown to interact with the p53 function. To investigate the immunohistochemical overexpression of mdm-2 protein in comparison with that of p53 protein in RCC, 50 nonpapillary pT3 RCCs were immunostained for p53 protein (DO-7) and mdm-2 (IF2). Tumor growth fraction (Ki-67 labeling index; MIB-1) was determined by immunohistochemistry. p53 positivity was detected in 16% of tumors. mdm-2 overexpression was seen in 30% of RCCs. There was a significant association between p53 and mdm-2 immunostaining (P = 0.0006), suggesting that mdm-2 protein may contribute to p53 protein stabilization in RCC. p53 overexpression was associated with a high Ki-67 LI (P = 0.0002), suggesting that p53 overexpression is involved in growth control in RCC. Survival analysis showed that Ki-67 LI (P = 0.04) and p53 overexpression were associated with poor prognosis (P = 0.0021), whereas mdm-2 overexpression was not related to patient outcome (P = 0.73). A Cox regression analysis revealed tumor stage (P < 0.001) and p53 overexpression (P < 0.05) to be independent prognostic parameters. It is concluded that p53 but not mdm-2 may be of practical relevance in predicting patient prognosis in RCC.

Nucleolar organizer regions and prognosis in glottic squamous cell carcinoma

BACKGROUND

The quantity of nucleolar organizer regions (AgNORs) appear to be prognostic significant in several tumor types.

METHODS

Sections from 93 routinely processed pretreatment biopsies from patients with glottic carcinomas were stained by silver nitrate and evaluated by two counting methods: (1) the mean number of AgNOR per tumor nucleus (mAgNOR), and (2) the number of tumor nuclei with one, two, three, four, and more than four AgNOR grains. From these figures the percentage of nuclei with one, two or less, three or less, and four or less AgNORs (pAgNOR1, aAgNOR < or = 2 etc) were calculated.

RESULTS

The median mAgNOR was 4.3, and low counts correlated favorably with the disease-free period (p = 0.0433). The median percentages for pAgNORs were 14, 26, 38, and 51 for pAgNor1, PAgNOR < or = 2, pAgNor < or = 3 and pAgNOR, < or = 4 respectively. Values above the medians correlated positively with the disease-free period (p-values ranging from 0.0005 to 0.0001). Although pAgNOR < or = 3 appeared to be the best discriminator by multivariate analysis, pAgNOR1 is the method of choice because this parameter is the easiest and quickest to perform.

CONCLUSION

pAgNOR counts appear to be a potent prognostic marker and may become useful in treatment decisions.

Staining of the nucleolar organizer regions: relevance in hematology

There is growing interest in staining for the nucleolar organizer regions to detect nucleolar organizer region-associated proteins. In some cases, this technique facilitates the study of hematological disorders and allows us to distinguish between certain pathologies. Furthermore, it can provide information about cell proliferation, activity and malignancy. This paper attempts to give the recent advances in the use of the staining of nucleolar organizer regions and its clinical relevance in hematology.

Flow cytometric quantitation of the proliferation-associated nuclear antigen p105 and DNA content in patients with renal cell carcinoma

BACKGROUND

Although tumor stage and grade are important prognostic parameters for patients with renal cell carcinoma, postnephrectomy survival is often difficult to predict. Therefore identifying patients at high risk for disease progression is critical. Using two-color flow cytometry, DNA and proliferation-associated nuclear antigen p105 contents were measured simultaneously in 75 patients with renal cell carcinomas and the ability of these results to predict the survival was assessed.

METHODS

Flow cytometric study of the proliferation-associated nuclear antigen p105 was done on cancer cell suspensions from 75 patients with renal cell carcinomas. By setting the cutoff line at the level between the brighter and the dimmer subpopulations in the diploid G0G1 region, the p105-labeling rate was calculated by the p-105DNA dual fluorescence analysis.

RESULTS

The mean p105-labeling rate was 66.8% (median: 67.6%; range: 33.9-93%). The 5-year survival rate of patients with high p105-labeling tumors was significantly lower than that of patients with low labeling tumors (P < 0.05). The following factors were examined univariantly as prognostic factors: Robson's stage, DNA ploidy pattern, grade, and p105-labeling rate. All of these factors except for DNA ploidy pattern were prognostic. The Cox multivariate regression analysis was performed with the three statistically significant variables. Accordingly, these three factors were significantly associated with survival rate and were found to be independent prognostic factors.

CONCLUSIONS

The measurement of p105 may provide useful information for predicting prognosis of patients with renal cell carcinoma.

Prognostic significance of nuclear DNA content and proliferative activity in renal cell carcinomas. A clinicopathologic study of 58 patients using mitotic count, MIB-1 staining, and DNA cytophotometry

BACKGROUND

For a variety of human malignancies, static DNA cytophotometry and immunostaining for the Ki-67 antigen using the antibody MIB-1 have provided significant prognostic information.

METHODS

Surgical specimens of 58 renal cell carcinomas (RCCs) were investigated by conventional histology, DNA cytophotometry, and MIB-1 immunostaining.

RESULTS

The MIB-1 indices and DNA data were found not only to be significantly correlated with various other morphologic parameters, but also to the clinical behavior of RCC. In the course of this study (median observation period: 31 months), 27% of patients died from RCC. None of these patients belonged to the group of 37 patients with RCCs exhibiting diploid or euploid DNA histograms. Lethal outcome occurred in only 16 of the 21 patients (76%) with noneuploid or aneuploid histogram tumors (P < 0.0001). According to their MIB-1 indices and upon choosing different cutoff levels, the 58 RCCs were categorized into 2 groups with either low or high proliferative activity. Using the median and the mean MIB-1 index as cutoffs, none of the patients with tumors showing low proliferative activity had died, whereas 16 of 29 patients (55%) or, respectively, 16 of 25 patients (64%) with tumors exhibiting high proliferative activity, had died from RCC (P < 0.0001).

CONCLUSIONS

In addition to tumor grade and stage, both a high MIB-1 index and a noneuploid or aneuploid DNA histogram of a given RCC have the potential to identify tumor patients with an impaired prognosis.

The relationship between vascularity and cell proliferation in human normal and pathological lesions of the oral cheek epithelium

The present study investigates relationships between neovascularisation and PCNA cell proliferation markers in different pathological lesions of the oral cheek mucosa. All specimens were fixed in 10% formalin and routinely processed for histology. Six normal (N) samples were taken from resection margins of benign lesions. The pathological lesions consisted of chronic inflammation (n = 10), lichen planus (n = 7), fibrous hyperplasia (n = 11), dysplasia (n = 5), squamous cell carcinoma (n = 22) and epithelium adjacent to carcinoma (n = 6). Adjacent 5 microns sections were stained with monoclonal antibodies against vimentin (clone no. V9) for identification of stromal blood vessels and against proliferating nuclear antigen (PCNA/PC10) using ABC immunoperoxidase techniques. Point counting was used to obtain the primary morphometric data using a Zeiss VIDAS image analyser. No attempt was made to classify the different types of blood vessels. The morphometric blood vessel parameters estimated were volume density, number per unit area, length per unit volume and mean transverse sectional area. PCNA indices were determined by estimating the percentage frequency of PCNA positive nuclei in basal and spinous strata. Generally, there were significant increases in all PCNA indices and blood vessel parameters between the N group and the different pathological lesions. A highly positive correlation was detected between all PCNA indices and blood vessel parameters. These data suggest that increased vascularity and angiogenesis occur in support of actively proliferating and transforming oral epithelial cells in order to permit growth. PCNA indices and blood vessel parameters may have a potential application as diagnostic and prognostic indicators.

Prognostic value of ploidy and proliferation markers in renal cell carcinoma

BACKGROUND

The prognosis for patients with renal cell carcinoma depends mainly on pathological stage and grade of the tumor at the time of surgery. Cellular proliferation may prove to be another measure for predicting biologic aggressiveness and, therefore, the prognosis.

METHODS

The authors compared four different methods to assess proliferation in a series of 87 curatively resected (R0) renal cell carcinomas: flow cytometry analysis (FCM), silver-stained nucleolar organizer regions (AgNOR), and immunohistochemical assessment of the MIB-1 (Ki-67) antigen, and proliferating cell nuclear antigen (PCNA). The results obtained were compared with pathologic stage (according to the International Union Against Cancer [UICC]) and grade with disease-related survival rate; finally, we assessed whether the methods led to similar results.

RESULTS

In each carcinoma examined, we could demonstrate MIB-1, PCNA, and AgNOR dots in varied proportions. Statistical correlations were seen between the tumor grade, the rate of nuclear positivity for MIB-1 and PCNA, and the number of AgNOR dots. Additionally, the MIB-1 index was significantly higher in more advanced tumor stages. A good correlation between MIB-1 and AgNOR as well as for PCNA was found. In univariate survival analysis, tumor stage and grade, MIB-1 and PCNA index, and mean AgNOR number were related significantly to patient survival. On multivariate Cox disease-related survival analysis, stage of disease and MIB-1 were significant independent prognostic factors. Flow cytometry was not related to prognosis nor to other examined parameters.

CONCLUSIONS

These results indicated that MIB-1 immunostaining is an additional prognostic parameter for patient outcome. MIB-1 and PCNA immunostaining, as well as AgNOR, demonstrated good correlations among themselves. We failed to establish flow cytometry as a method to predict proliferative capacity or prognosis in renal cell carcinoma patients.

Significance of conventional and new prognostic factors for locally confined renal cell carcinoma

BACKGROUND

The prognosis of patients with locally confined renal cell carcinoma is variable. To improve the prognostic knowledge and select patients at high risk, additional prognostic parameters are needed.

METHODS

The significance with respect to survival and tumor recurrence of "classic" and "new" prognostic parameters has been examined by following 41 patients with locally confined renal cell carcinoma after nephrectomy (mean follow-up, 5.2 years). The significance of histologic grade, tumor stage, Ki-67 index, proliferating cell nuclear antigen index, 3H-thymidine labeling index, tumor ploidy status, and tumor growth after xenotransplantation into nude mice (GAX range) was tested using the Kaplan-Meier plots by the log rank test or Tarone's test and also by the Cox multiple hazard regression analysis.

RESULTS

Tumor stage (P < 0.0025), histologic grade (P < 0.005), Ki-67 index (P < 0.006), and GAX range (P < 0.00004) were found to be significant prognostic parameters for survival and tumor recurrence using single-factor analysis. Applying the multivariate analysis, the combination of the "new" factors, GAX range and Ki-67 index, resulted in even a higher prognostic relevance than the combination of the "classic" prognostic factors, tumor stage and histologic grade. The calculated prognostic index based on the results of the Cox analysis, which, except for stage and grade, included the Ki-67 index, was shown to be highly correlated with survival (P = 0.00002) and tumor recurrence (P = 0.0004). Its prognostic validity was studied with the receiver operating characteristics procedure and was found to be considerably superior to that of the two conventional prognosticators.

CONCLUSIONS

The additional determination of the Ki-67 labeling index increases the prognostic assessment of patients with locally confined renal cell carcinoma.

Expression of proliferating cell nuclear antigen in basal cell carcinomas and in squamous cell carcinomas of canine skin: correlation with mitotic index and histological features

In this study we evaluated the behaviour of proliferating cell nuclear antigen labelling index (PCNA-LI), mitotic index (MI) and histological features in ten basal cell carcinomas (BCC) and ten squamous cell carcinomas (SCC) of canine skin. PCNA-LI ranged from 2.1% to 4.8% in SCC and from 0.1% to 2.0% in BCC samples. A significant statistical correlation, between PCNA-LI and MI could be demonstrated only in SCC, but not in BCC samples. Furthermore, PCNA-LI was also significantly and consistently greater in the three BCC of solid type and in poorly differentiated SCC. PCNA-LI may provide additional criterion in evaluating the intrinsic malignancy and growth potential of the above tumours.

Renal cancer and tumoral markers: Biological features and prognostic implications

In this work we have examined the studies carried out on tumoral markers of renal carcinoma, in order to point out useful characteristics for understanding the evolution of the tumour. We have examined the cytogenetic studies, the molecular oncology, the studies of cellular proliferation and the DNA analysis, reporting our own experience on the last method. However clashing opinions stili exist on the predictive ability of these investigations. DNA analysis by cytometry seems to be the most applicable one at a clinical level.

Proliferation of renal cell carcinoma assessed by fixation-resistant polyclonal Ki-67 antibody labeling. Correlation with clinical outcome

BACKGROUND

Although tumor staging is an important prognostic parameter for renal cell carcinoma (RCC), postnephrectomy survival interval is often difficult to predict for individual patients. This is the result of varied growth characteristics, which in tumors of similar stage govern both time to recurrence and rate of tumor dissemination. Polyclonal Ki-67 antibody labels a proliferation-specific antigen expressed in actively proliferating cells and is applicable to formalin fixed paraffin embedded archival tissue. This study was designed to test the prognostic utility of Ki-67 antigen labeling in a series of RCC and to compare the data with those derived from other markers of cell proliferation.

METHODS

Polyclonal Ki-67 antibody staining of 206 cases of RCC was undertaken using the streptavidin-biotin method. Cases were grouped according to Ki-67 indices and Kaplan-Meier survival curves were constructed. Groups were compared in terms of survival for all cases and for each of Robson's stages using the log rank test. Further sections were stained for proliferating cell nuclear antigen (PCNA) and silver-staining nucleolar organizer regions (AgNORs). The prognostic significance of Ki-67 antigen, PCNA and AgNOR staining, histologic grade, and tumor stage were compared using Cox's proportional hazard model.

RESULTS

Ki-67 immunostaining was achieved for 173 cases with indices ranging from 0.1% to 30.4%. Division of tumors with indices 6% or less and greater than 6% showed a significant difference in survival between groups for all cases and for each Robson stage. Ki-67 and PCNA indices, AgNOR scores, and tumor dissemination (Robson Stage 3 and 4) retained a significant association with survival on multivariate analysis.

CONCLUSIONS

Polyclonal Ki-67 antibody immunostaining provides significant survival information that complements that derived by other markers of cell proliferation and tumor staging.

Comparison of silver-staining nucleolar organizer region (AgNOR) counts and proliferating cell nuclear antigen (PCNA) expression in reactive mesothelial hyperplasia and malignant mesothelioma

Previous workers have used counts of colloidal silver-stained nucleolar organizer regions (AgNORs) to help distinguish reactive from malignant mesothelial processes. We sought to compare the demanding technique of AgNOR counting with the identification of proliferating cell nuclear antigen (PCNA) in 10 pleural malignant mesotheliomas and 11 reactive mesothelial proliferations. The mean AgNOR count was significantly higher in malignant compared to reactive lesions (5.10 [95% confidence interval, CI 4.35-5.84] vs 3.68 [95% CI 3.17-4.19], p = 0.004), as was the PCNA index (26.9 [95% CI 17.37-36.49] vs 9.67 [95% CI 4.94-14.39], p = 0.004). Less overlap was seen with PCNA indices and no reactive mesothelial proliferations had a PCNA index greater than 20%, suggesting that scores over this level may be a specific indicator of malignancy in this setting. There was only a weak correlation between the 2 proliferation indices suggesting that PCNA and AgNORs are present at somewhat different times of the cell cycle and/or persist in the post-S phase cell for variable lengths of time.

Proliferating cell nuclear antigen but not p53 or human papillomavirus DNA correlates with advanced clinical stage in renal cell carcinoma

In this study we investigated 56 renal cell carcinomas immunohistochemically for the expression of proliferating cell nuclear antigen (PCNA) and tumour suppressor protein p53. We also analyzed for the presence of human papilloma virus (HPV) DNA subtypes 6, 11, 16, 18, 31 and 33 by in situ hybridization. In carcinomas which showed more than 10% of PCNA positive nuclei there were significantly more cases with invasion (P = 0.032) or metastatic disease (P = 0.047). Nine out of 22 grade III-IV tumours (40.9%) but only six out of 30 grade I-II tumours (20%) showed more than 10% of PCNA positive cells (P = 0.097). Patients with 10% or more PCNA positive cells in kidney tumours had more advanced disease at the time of diagnosis than those showing less PCNA positive cells (P = 0.05). Six p53 positive cases were found among 56 tumours (11%), but only one case had more than 10% positive cell nuclei. The presence of HPV DNA was found in 29 out of 56 cases (52%). Multiple subtypes were found in 19 cases (34%). The most commonly occurring subtypes were 18 and 33. There was no association between PCNA, p53 and the presence of HPV DNA subtypes. Because of the association of PCNA with invasion and metastatic disease, it would be worth while to study PCNA further as a possible marker for aggressiveness of renal carcinomas. Both this study and those concentrated on mutational analysis suggest that p53 is generally not important for the development of renal cell carcinoma. On the other hand, the presence of HPV DNA in these tumours implicates HPV viral infection in the aetiology of renal cancer.

Computerized nuclear morphometry and survival in renal cell carcinoma: comparison with other prognostic indicators

Morphometric nuclear parameters were compared with patient survival for a series of 174 renal cell carcinomas (RCC) collected over a 30 yr period. Stepdown regression showed long diameter, average feret diameter, form factor and the ratio of average feret diameter to equivalent diameter to be significantly associated with survival. Nuclear area, nuclear perimeter, equivalent diameter, ratio of long diameter to average feret diameter and coefficients of variation of nuclear area and nuclear perimeter were not significantly correlated with survival. All parameters were correlated with a 3 division nuclear grading classification using analysis of variance. Multivariate analysis showed nuclear form factor, tumor stage, silver staining nucleolar organizer region numbers and proliferating cell nuclear antigen expression to be independently associated with survival. The results of this study indicate that form factor is the most discriminate morphometric parameter for RCC, providing survival data additional to that derived from tumor staging and from markers of tumor proliferation.

Nuclear quantitative grading by discriminant analysis of renal cell carcinoma samples. A patient survival evaluation

Specimens from 60 cases of renal cell carcinoma (RCC) were graded employing quantitative nuclear data combined with multivariate discriminant analysis. Evaluation of patient survival was analysed with respect to quantitative microscopic and qualitative features. Both morphometric and stereological estimators were used to establish the nuclear size and form pattern of the RCC specimens. Tumoural dedifferentiation paralleled progressive increases in nuclear elongation and in two- and, especially, three-dimensional--mean nuclear volume (MNV)--size parameters. Using stepwise discriminant analysis, 85.0 per cent of the specimens were correctly classified when differentiating grade 2 and 3 tumours. It is concluded that simple and realistic estimates of MNV are the best discriminator for objective grading in patients with RCC. Univariate survival analysis demonstrated the important significance of several features such as MNV, clinical stage, and nuclear discriminant and histopathological tumour grades. Nuclear form factor PE, area, and perimeter were also significant. A prognosis study based on the Cox model using a stepwise selection of parameters showed that only MNV has an independent prognostic role when examining all investigated quantitative parameters. The clinical stage was the best prognostic feature when all quantitative and qualitative characteristics were included in the analysis.

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.