Stereologyによる膀胱腫瘍細胞平均核容積の臨床的意義について : grade,stage,予後との関連

Abstract

膀胱腫瘍細胞の平均核容積(MNV)をstereologyの理論を用いて計測し, 患者予後との関係を検討した.1) grade, stageの高い症例は腫瘍細胞のMNVが大きかった.2) MNVの小さな群(MNV<197.3 μm3)は, 大きな群(MNV≧197.3 μm3)と比べて生存率および非再発率が有意に高かった.3) grade 2の症例をMNVに大きさによって2群に分類すると, MNVが197.3 μm3未満の症例の生存曲線は, grade 1の生存曲線にほぼ一致し, MNVが197.3 μm3以上の症例の生存曲線は, grade 3のものによく一致した.4) MNVは簡便な方法で測定でき, しかも膀胱腫瘍の悪性度を定量的に示すことができる指標になりうると思われた

Quantitative analysis of the malignant potential in cancer cells is a method currently under discussion. Recently the stereological estimation of cancer cells has been utilized in making an objective and quantitative pathological diagnosis. In this study, we estimated the mean nuclear volume (MNV) of untreated bladder carcinomas in 128 patients by stereological methods and attempted to quantitatively analyze the malignant potential of the carcinoma. The MNV was significantly enlarged as the tumor advanced in grade and stage. MNV was largest in grade 3 tumors (340.2 +/- 100.1 microns3) followed by grade 2 tumours (206.2 +/- 90.6 microns3) (P less than 0.01), and grade 1 tumors (130.6 +/- 46.7 microns3) (P less than 0.01). MNV was larger in pT1 tumors (278.2 +/- 126.9 microns3) than in pTa tumors (156.9 +/- 60.5 microns3) (P less than 0.01). MNV was also larger in invasive tumors (T2, T3 and T4: 318.2 +/- 104.0 microns3) than in superficial tumors (Ta and T1: 203.5 +/- 109.2 microns3) (P less than 0.01). Patients were then divided into two subgroups, one with large nuclei (MNV greater than or equal to 197.3 microns3), and the other with small nuclei (MNV less than 197.3 microns3). Survival and disease-free rates in patients with small nuclei (5-year survival rate: 92.9%, 5-year disease-free rate: 24.4%) were significantly better than in patients with large nuclei (5-year survival rate: 58.0%, 5-year disease-free rate: 12.5%). For patients with grade 2 tumors, those with small nuclei had a good survival rate (5-year survival rate: 95.5%), similar to that of patients with grade 1 tumors (5-year survival rate: 95.0%).(ABSTRACT TRUNCATED AT 250 WORDS)