Nucleolar Organizer Regions as a Prognostic Indicator in Epithelial Cancers of the Ovary

The AgNORs count in predicting long-term survival in serous ovarian cancer

INTRODUCTION

The value of argyrophilic nucleolar organizer regions (AgNORs) to predict survival in patients with ovarian cancer has not been clearly explained yet. The aim of study was to assess the value of analysis of the mean number of AgNORs per nucleus (mAgNOR) and mean percentage of nuclei with five or more AgNORs per nucleus (pAgNOR) in the prediction of disease-free survival (DFS) and overall survival (OS) in patients with serous ovarian cancer.

MATERIAL AND METHODS

The study examined 52 patients treated for serous ovarian cancer with a follow-up period of 2-143 months. After silver staining paraffin specimens from primary surgery, mAgNOR and pAgNOR in cancer cells were counted and analyzed. Age, grading, radicality of surgery and FIGO staging were analyzed as covariates.

RESULTS

Mean mAgNOR equaled 4.4 ±0.9 and pAgNOR equaled 42.2 ±20.8%. Both mAgNOR and pAgNOR were the lowest in G1 tumors. The mAgNOR and pAgNOR were lower in stage I than stage IV cancers. The DFS and OS rates were respectively 15.4% and 21.2%. In univariate analysis FIGO staging, grading, and pAgNOR were associated with worse prognosis, while radicality of surgery remained a significant protective factor in terms of DFS. Higher FIGO staging and older age worsened OS. In multivariate analysis FIGO staging remained significantly associated with both DFS (HR 1.98; 95% CI 1.05-3.71) and OS (HR 1.76; 95% CI 1.00-3.10), while age affected OS rates (HR 1.78; 95% CI 1.04-2.95).

CONCLUSIONS

mAgNOR and pAgNOR are useful markers of cellular kinetics. Prospective studies in larger populations are needed to confirm these results in terms of AgNORs' effects on survival.

Assessment of the argyrophilic nucleolar organizer region area/nucleus ratio in ovarian serous epithelial adenomas, borderline tumors and cancers

INTRODUCTION

There is a need to assess the value of the novel potentially useful biomarkers in ovarian tumors. The aim of study was to assess the value of sAgNOR analysis in ovarian serous epithelial tumors.

MATERIAL AND METHODS

The analysis was performed in ovaries from 113 patients treated operatively due to serous ovarian tumors (30 adenomas, 14 borderline tumors and 69 cancers). After silver staining of paraffin specimens from surgery, sAgNOR in tumor cells was analyzed. Additionally, the value of the argyrophilic nucleolar organizer region area/nucleus ratio (sAgNOR) in the prediction of disease-free survival (DFS) and overall survival (OS) in 52 patients with serous ovarian cancer with complete follow-ups in November 2009 was evaluated. Age, grading, radicality of surgery and FIGO staging were analyzed as additional factors.

RESULTS

SAGNOR IN ADENOMAS, BORDERLINE TUMORS AND CANCERS WAS IN THE FOLLOWING RANGES: (0.73 ±0.23) × 10(6), (0.81 ±0.18) × 10(6) and (0.96 ±0.33) × 10(6) [AgNOR/cm(2)] respectively. In cancers from G1 to G3 sAgNOR was (1.02 ±0.32) × 10(6) (G1), (0.98 ±0.37) × 10(6) (G2) and (0.82 ±0.24) × 10(6) (G3) [AgNOR/cm(2)] respectively. In univariate analysis, but not in multivariate analysis, staging negatively correlated with better DFS and OS. sAgNOR, age of patients, grading and radicality of surgery were not associated with DFS or OS in either univariate or multivariate analysis.

CONCLUSIONS

sAgNOR analysis is not sufficient to precisely characterize cellular kinetics in serous ovarian tumors, and the analysis of sAgNOR, mAgNOR and pAgNOR should be performed commonly. The prognostic significance of sAgNOR in patients with serous ovarian cancer was not proven.

Effects of Spirulina platensis extract on Syrian hamster cheek pouch mucosa painted with 7,12-dimethylbenz[a]anthracene

Research into cancer prevention seeks to identify the preventable causes of cancer, and to reduce cancer incidence by effective implementation of preventative strategies in target populations. In this study, 30 male golden Syrian hamsters were divided into three equal groups; the right buccal pouches of the hamster rats in group one were painted with 0.5% solution of 7,12-dimethylbenz[a]anthracene (DMBA), three times a week, until sacrificed. The same pouches of group two were also painted with DMBA, but received an additional 10mg/daily Spirulina platensis extract, which was added to the soft diet supplements during the same period. The hamster rats in group three received neither DMBA nor S. platensis extract. They were painted with saline and served as control animals. Half the hamsters from each of the three groups were sacrificed by ether inhalation after 7 weeks, and the remaining half were sacrificed after 14 weeks. The required buccal pouches were surgically excised and prepared for regular H&E and argyrophilic proteins of the nuclear organizer regions (AgNOR) silver staining. AgNORs counting and statistical analysis were carried out. We observed moderate dysplastic changes extending into the midspinous layer in group one 7 weeks after DMBA painting, which reached to half the thickness of the hyperplastic epithelium after 14 weeks. However, in group two, mild dysplastic changes were observed after 7 weeks, which were restricted to the basilar and parabasilar layers of the epithelium after 14 weeks of treatment. AgNOR staining in group one produced AgNOR counts ranging from one to seven dots per nucleus, whereas the counts were one or two dots per nucleus in group two. The AgNOR mean number in groups one, two and three was (3.1+/-0.006, 1.3+/-0.003 and 1.2+/-0.003, respectively). Moreover, with one sample t-test, a significant difference was found in AgNOR mean number between groups one and two, groups one and three and between groups two and three (P<0.05). An overall significant difference among the three groups (P<0.01) was indicated with one-way analysis of variance. The pAgNOR was 10% in group one, 5% in group two and 4% in group three. Consequently, S. platensis is an adjunctive means to inhibit the dysplastic changes occurring in the hamster cheek pouch (HCP) mucosa. However, more research is needed to expand its beneficial action.

Silver-stained nucleolar organizer regions in normal and dysplastic cervical lesions: correlation with DNA ploidy and S-phase fraction by flow cytometry

OBJECTIVES

To investigate the prognostic significance of DNA ploidy and silver-stained nucleolar organizer regions (AgNOR), their relation to the cytological grades of cervical dysplasia and correlation of cells in the S-phase of the cell cycle and DNA ploidy with AgNOR count.

METHODS

Multiparametric DNA flow-cytometric analysis and AgNOR count were performed on cervical smear samples, cytologically diagnosed as normal (n = 196), atypical squamous cells of unknown significance (ASCUS, n = 98) and various grades of cervical dysplasia (n = 127).

RESULTS

Among the cytological grade, aneuploid cases from low-grade squamous intraepithelial lesion (mild) and high-grade squamous intraepithelial lesion (moderate and severe) groups were showing high AgNOR counts (ranges 4.33-5.86 and 5.91-7.42, respectively). Aneuploid cases from the ASCUS group also presented high AgNOR (range 3.72-4.93). The high percentage of cells in the S-phase (>12%) correlated with these 2 parameters in the ASCUS and dysplasia groups. After grouping the cases into those with high (>4.0) and low (<4.0) AgNOR counts, significant correlations in the group with high AgNOR count with DNA ploidy, S-phase and cytological grade were recorded (p < 0.001). Results obtained from follow-up study revealed that cases with aneuploidy, high AgNOR count and S-phase fraction presented with a progressive trend of disease.

CONCLUSIONS

Thus, the study shows that high AgNOR count, S-phase fraction and aneuploid DNA have prognostic significance in the early detection of cervical cancer.

Morphometry and digital AgNOR analysis in cytological imprints of benign, borderline and malignant serous ovarian tumours

AIM

The aim of the study was to determine values of a quantitative morphometry analysis of nuclear characteristics and argyrophilic nucleolar organizer regions (AgNORs) in differential cytodiagnosis of benign, atypically proliferating (borderline) and malignant serous ovarian tumours.

METHODS

Cytological imprints of benign (n = 20), borderline (n = 19) and malignant (n = 20) ovarian serous tumours were analysed. A computerized, digital analysis was used to determine morphometric nuclear features, the number and characteristics of single AgNORs, cluster AgNORs, total AgNOR and AgNOR area/nucleus (relative area) ratio. According to their size AgNORs were classified in three categories. A one-way variance analysis and post hoc test (Scheffé) were used for statistical analysis.

RESULTS

The morphometric nuclear analysis showed that benign, borderline and malignant serous ovarian tumours are statistically different (P < 0.001) according to the area and outline, the values being highest in malignant tumours and lowest in the borderline group. Digital analysis of AgNORs in benign, borderline and malignant groups showed that the total AgNOR number increases with progression of the lesion (meaning tumour malignancy) significantly (P < 0.001) between benign and malignant as well as between borderline and malignant serous ovarian tumours (P < 0.001). The progression of the lesion malignancy was accompanied by a significant (P < 0.001) progressive increase of the total and relative AgNOR area per nucleus. The AgNOR size increases from benign to malignant tumours and a statistically significant difference (P < 0.001) was observed in all three groups regarding small and large AgNORs.

CONCLUSION

Combining different markers of morphometric nuclear characteristics and AgNOR values could improve differential cytodiagnosis of benign, borderline and malignant serous ovarian tumours.

Value of Silver Binding Nucleolar Organiser Regions (AgNOR) in Squamous Cell Carcinomas of Upper Aero-digestive Tract

BACKGROUND

Study of Silver-binding nucleolar organizing regions (AgNORs) in 50 cases of squamous cell carcinomas (SCC) of upper Aero-digestive tract was carried out with an aim of correlating AgNOR positivity with histological grade of tumour and evaluating value of AgNOR staining in predicting the progress of disease.

METHODS

Tissue sections of the cases were stained with 50 percent silver nitrate solution for AgNOR evaluation and the data analysed. All the sections were also stained with haematoxylin and eosin stain for tumour typing and grading.

RESULTS

In this study, the mean AgNOR (mAgNOR) score of normal squamous epithelium (50 cases) was 1.56 (range1.00-2.80), that of well differentiated squamous carcinoma (27 cases) was 3.29 (range 2.4-4.6), moderately differentiated squamous carcinoma (21 cases) was 4.29 (range 2.7-5.6) and of poorly differentiated squamous cell carcinoma (2 cases) was 5.21. The mAgNOR scores were statistically significant. Comparison of the percentage AgNOR (pAgNOR) scores between well differentiated and moderately differentiated carcinomas showed that all the pAgNOR values (1-9) were significant. However, pAgNOR 3 and pAgNOR 4 were most significant. Cut off values for pAgNOR score to differentiate between the various grades of squamous cell carcinomas could not be calculated due to lack of data on survival rates.

CONCLUSION

AgNOR technique can definitely be used as a supportive tool to routinely performed Hemotoxylin and Eosin staining and may help in prognosis as well as therapeutic decision-making in squamous cell carcinomas. Studies of larger number of cases in a prospective study are needed to arrive at more substantial conclusions.