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 : 続報 核の断面積,円形度,不同性を加えた検討

Abstract

膀胱腫瘍細胞核の形態を表すパラメーターとして平均核容積(MNV), 平均核断面積(MNA), 核の円形度(NRF), 核の大小不同性(VNA)を計測し, 膀胱腫瘍の悪性度の定量的解析を検討した.1) grade, stageの高い症例は腫瘍細胞のMNV, MNA, VNAが大きかった.2)膀胱腫瘍では, MNV, MNA, NRFの小さな群は大きな群と比較して生存率が有意に高かった.3)膀胱腫瘍grade 2の症例では, MNVの小さな群は大きな群と比較して生存率が有意に高くMNVの小さな群の生存曲線は, grade 1の生存曲線にほぼ一致した.4)表在性膀胱腫瘍では, MNV, NRFの小さな群は大きな群と比較して非再発率が有意に高かった.5)浸潤性膀胱腫瘍では, NRFの小さな群は大きな群と比較して生存率が有意に高かった.6) MNV, MNA, NRFは, 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

Recently, nuclear morphometry methods have been used to quantitatively analyze the malignant potential of cancer cells. We have previously shown that the malignant potential of human bladder carcinoma can be analyzed quantitatively through mean nuclear volume measurements. In the present study, we examined other measurements obtained from nuclear morphometry and evaluated their usefulness as indicators of the outcome of bladder carcinoma. Our subject group consisted of 161 patients with untreated bladder carcinoma. Four nuclear morphometric values were measured on each subject: the mean nuclear volume (MNV), the mean nuclear area (MNA), the nuclear roundness factor (NRF) and the variation of nuclear area (VNA). MNV, MNA and VNA values increased as the tumors progressed to a more advanced stage and grade of malignancy. Patients were then divided into two subgroups based on each morphometric value: small MNV ( or = 186.9 microns3); small MNA ( or = 33.6 microns2); low NRF ( or = 81.1); and low VNA ( or = 33.0). Survival rates were significantly higher among patients with a small MNV, a small MNA and a low NRF (5-year survival rate; 93.0, 84.9 and 84.6%), compared to patients exhibiting high values (5-year survival rate; 59.7, 61.3 and 61.9%). For patients with grade 2 tumors, those with a small MNV had a high survival rate (5-year survival rate; 95.2%), similar to that of patients with grade 1 tumors (5-year survival rate; 95.2%)(ABSTRACT TRUNCATED AT 250 WORDS)