Interphase nucleolar organiser regions and survival in squamous cell carcinoma of the bronchus: a 10 year follow up study of 138 cases

Apoptosis in squamous cell carcinoma of the lung: correlation with survival and clinicopathological features

AIMS

Apoptosis is recognised as a physiological mechanism for controlling cell numbers and its subversion is thought to contribute to carcinogenesis. The aims of this study were to measure the apoptotic index (AI) in a series of squamous cell carcinomas (SCCs) of the lung using standard histological staining and confirm this by immunohistology using an antibody to an apoptosis specific protein (ASP), and to seek to correlate the AI with clinicopathological parameters.

METHODS

Sections of 134 SCCs were stained by haematoxylin and eosin (H&E) for counting apoptotic bodies of determine the AI (number of apoptotic bodies/10,000 tumour cells); 26 of these were also stained with anti-ASP antibody and the proportion of ASP positive cells counted. Clinical data were obtained from hospital notes.

RESULTS

The mean AI obtained by H&E staining of all 134 SCCs was 30.3 (SD, 24.75). Anti-ASP staining allowed easy identification of apoptotic bodies, and generated a somewhat higher index (mean, 51.4; SD 39); this was not a result of the selection of tumours because the AI by H&E in the subset stained with anti-ASP was 31.1. Regression analysis showed that the correlation between the two values of AI was highly significant (Rs = 0.9760; p < 0.001), indicating that the two methods were both reliable measures of apoptosis but that the anti-ASP staining is the more sensitive method. The tumours were grouped into high AI (> 50) and low AI (< 50) and survival analysis was carried out. The mean survival of the high AI group was 109 weeks and of the low AI group 72 weeks (p = 0.036).

CONCLUSIONS

Anti-ASP staining is a reliable, easy, and sensitive method for assessing apoptosis in tumour sections and confirms the validity of the AI obtained by H&E staining. AI is a guide to the behaviour of SCCs of the lung.

CD40 and Bcl2 expression in squamous cell carcinoma of the lung: correlation with apoptosis, survival, and other clinicopathological factors

CD40 is a cell surface receptor which, when ligated, modulates apoptosis in some cell types, perhaps via activation of the expression of members of the Bcl2 gene family. This study sought to determine whether expression of CD40 in a series of 134 squamous cell carcinomas (SCCs) of the lung was related to apoptosis or clinical parameters, either alone or in connection with Bcl2 expression. Sections of SCCs were stained for CD40 and Bcl2 by immunohistochemical techniques. An index was determined for these two markers by counting stained and unstained malignant cells under high power. Sections were also stained by haematoxylin and eosin for determination of the apoptotic index by counting apoptotic bodies. About 40 per cent of SCCs expressed CD40 in at least some of the malignant cells, with about 10 per cent essentially uniformly stained. Similar proportions expressed Bcl2, with a tendency for expression to be mutually excluisve. Apoptosis did not correlate with CD40 expression, nor was there evidence of a co-operative or an antagonistic effect with Bcl2. Bcl2 expression, on the other hand, correlated significantly with the apoptosis score. CD40 expression showed no significant relationship with survival or any other clinicopathological parameter except ploidy. Bcl2 expression, however, correlated with longer survival. It is concluded that CD40 expression in SCC of the lung does not by itself relate to apoptosis, nor is it a useful indicator of prognosis.

Evaluation of argyrophilic nucleolar organizer regions in tongue squamous cell carcinomas

Using a silver staining technique, argyrophilic nucleolar organizer regions (AgNORs) were studied on the biopsy specimens taken from 67 tongue squamous cell carcinomas (SCCs), and the relations of the results of AgNORs to the clinicopathological findings, to the labelling indices of proliferating cell nuclear antigen (PCNA LI), and to the outcomes of the disease were investigated. The mean numbers of AgNORs per cell were 1.67 +/- 0.19 (n = 27) in the control squamous epithelia and 3.58 +/- 1.15 (n = 67) in the tongue SCCs, respectively, and a significant difference was found between the two groups (P < 0.0001). Concerning the clinicopathological findings, the mean numbers of AgNORs in the progressive cases (T3, T4), in the factor N-positive groups (N1, N2), and in the advanced stages (stages III, IV) were statistically higher than those in T1, T2, N0, and earlier stage (stages I, II) tumours, respectively. Similarly, a higher value of the AgNOR count was present in the histological grade III or diffuse invasive tumour. There was also a directly significant correlation between the AgNOR counts and the labelling indices of PCNA (r = 0.53, P < 0.0001). Concerning the outcome of the disease, the mean numbers of AgNORs were higher in the group with local recurrence or with lymph-node metastasis. A lower rate of 5 years' survival was found in the high value group (63.5%) of AgNORs compared with that of the low value group (86.0%), with a significant difference between the two groups (P < 0.05). The results suggest that AgNORs may reflect the degree of malignancy and cellular proliferation in tongue SCCs.

Proliferative activity of esophageal carcinomas and their lymph node metastases: comparison using argyrophilic nucleolar organizer region staining

BACKGROUND

Many reports have concluded that quantification of the argyrophilic nucleolar organizer regions (AgNORs) measures proliferative activity and is a prognostic indicator in malignant disease. This retrospective study set out to evaluate the relationship between the AgNORs of the primary tumors and those of lymph node metastases in esophageal carcinoma.

METHODS

Using a one-step silver staining technique, AgNORs were counted in surgical specimens from 54 patients with squamous cell carcinomas.

RESULTS

The AgNOR scores of the lymph nodes metastases were significantly lower than those of the primary tumor (P = 0.0001). In 53 of 54 cases (98%), the AgNOR scores in the nodal metastases were lower than those of the primary tumor. The survival of 22 patients with AgNOR scores > or =4.0 for the primary tumor was significantly less than that of 32 patients with AgNOR scores <4.0 for the primary tumor (P = 0.0014).

CONCLUSIONS

The AgNOR score of the lymph node metastases had no prognostic significance. The AgNOR score of esophageal primary cancer reflects the prognosis of patients. Scores for lymph node metastases were lower and did not reflect prognosis. The lower score in the lymph node metastases may result from the antitumor activity of macrophages in the lymph nodes.

AgNORs and myeloma prognosis

The argyrophilic nucleolar organizer regions (AgNORs) were analysed in bone marrow biopsies from 80 patients with multiple myeloma (MM) at presentation. The mean AgNOR number per MM cell (AgNOR counts) and their distribution within the nucleus (configuration) were assessed. AgNOR counts were significantly associated with several recognized prognostic factors: Durie and Salmon clinical staging system (p = 0.02), percentage of plasma cells (PCs) in aspirates (p = 0.01) and in bone marrow biopsies (p = 0.0000), pattern of bone marrow involvement (p = 0.0003), calcaemia (p = 0.0005) and creatininaemia (p = 0.0003). AgNOR counts were also associated with the degree of PC differentiation (p = 0.0000). A single central cluster of 2-3 large-sized AgNORs (configuration A) was evident in most G1 MM; one cluster of 4-5 medium-sized dots or two clusters of 2-4 dots (configuration B) were seen in most G2 MM; many small-sized, scattered dots were present in G3 MM (configuration C). AgNOR counts and configuration were related to the prognosis: in the univariate analysis, the 5 year survival rate was 7% for cases with > 4.5 AgNORs/cell and 46% for cases with < or = 4.5 AgNORs/cell (p = 0.01), 53% for configuration A, 12% for configuration B and 0% for configuration C (p = 0.0000). AgNOR counts (p = 0.02) and configuration (p = 0.000) were independent prognostic variables in the multivariate analysis. The AgNOR counts were significantly higher in "fulminant myeloma" than in less aggressive cases (p = 0.002). The plasma cell labelling index (LI%), evaluated in 44 MM patients, showed significant correlation with prognosis: the 5 year survival rate was 51% for LI% < or = 1 and 17% for LI% > 1 (p = 0.02). More than 70% of patients with low LI% had low AgNOR counts and more than 70% of patients with high LI% had high AgNOR counts (p = 0.007). AgNOR counts and configuration reflect the myeloma cell mass, the degree of differentiation and the kinetics of the myeloma cells. They offer an exact evaluation of the tumour characteristics and can be useful additional parameters for MM prognosis.

Nucleolar organizer regions are independently associated with a shortened survival in patients with non-small cell lung cancer

We examined nucleolar organizer regions (Ag-NOR) in 102 patients with non-small cell lung cancer (NSCLC). Ag-NOR counts were generally higher in tumours from more advanced stages, or in poorly differentiated adenocarcinomas. Six potential-prognostic indicators included sex, age, year of operation, histology, stage and Ag-NOR count. Stage and Ag-NOR counts had a significant prognostic value in the univariate analysis for 79 patients who died of their lung cancer. In the multivariate analysis, high Ag-NOR counts as well as disease stage were independently associated with a poor prognosis. Furthermore we divided patients into three groups according to their Ag-NOR counts and found that in patients with stage I and II disease higher Ag-NOR counts were associated with shortened survival. This trend did not continue in patients with stage III and IV disease.

Prognostic value of nucleolar organizer regions in neuroendocrine tumours of the lung

The value of the number and size of the nucleolar organizer regions (NORs) as prognostic indicators in human neuroendocrine lung tumours was evaluated in a quantitative study of 57 cases, including 33 small cell carcinomas (SCLCs), 9 well-differentiated neuroendocrine carcinomas (WDNECs) and 15 "classic" carcinoids. NORs were visualized on paraffin sections by an argyrophilic technique (AgNOR) and measured by automatic image analysis. In each case, the mean number and area of AgNORs were evaluated; the results were compared with clinical follow-up and survival. AgNOR values for both number and area were significantly higher in SCLCs than in WDNECs and carcinoids. WDNECs had insignificantly higher AgNOR values than carcinoids. Among SCLCs, AgNOR values of the oat cell subtype and the intermediate cell subtype did not differ significantly. Regardless of the histological tumour type, AgNOR values strongly correlated with prognosis, with more and larger AgNORs indicating a more progressive clinical course. In the present study we demonstrate for the first time that the biological behaviour of neuroendocrine lung tumours is correlated with the number and size of AgNORs. Thus the measurement of AgNORs may serve as an additional prognostic indicator in these neoplasms, particularly in the separation of SCLCs from WDNECs with a more favourable prognosis.

Nucleolar organiser regions as a marker of growth rate in squamous cell carcinoma of the lung

BACKGROUND

The numbers of nucleolar organiser regions (AgNORs) per cell has been considered as an indicator of the cellular proliferative activity. A study was carried out to examine whether AgNOR numbers relate to the growth rate in squamous cell carcinoma of the lung.

METHODS

AgNORs were stained by a one step silver method, and examined in representative paraffin sections from 45 cases of squamous cell carcinoma of the lung treated by surgical resection of the primary tumour.

RESULTS

The mean (SD) AgNOR numbers per cell in squamous cell carcinomas (5.3 (0.9)) were significantly higher than those in normal bronchial epithelium (1.2 (0.1)). There was no statistical difference among tumours of different post-surgical stages (stage I = 5.2 (0.8), II = 5.9 (1.4), III A = 5.5 (1.3)). The tumour volume doubling time in these cases ranged from 74 to 208 days (120.7 (40.4)). There was a high inverse correlation between the AgNOR numbers and doubling time.

CONCLUSION

The AgNOR numbers were related to the growth rate of squamous cell carcinoma of the lung. Thus the AgNOR count could be used as a useful marker for investigating the cellular proliferative activity.