DNA倍体及核形态参数检测在肾细胞癌预后判断中的价值

Prognostic value of DNA ploidy and nuclear morphometry in renal cell carcinoma

目的 :探讨图像细胞术测定肾细胞癌DNA倍体和核形态参数在预后判断上的价值及其与病变分级的关系。方法 :根据Fuhrman等建议的病理分级系统对 4 7例肾细胞癌进行分级 ,肿瘤组织切片经Feulgen染色后 ,应用图像分析仪测量肾细胞癌的DNA倍体以及细胞核形态参数并结合临床随访资料进行统计分析。结果 :平均DNA倍体分布在FuhrmanⅠ～Ⅱ级主要为 2C ,≥ 5C的细胞少于 10 % ,Ⅲ～Ⅳ级中 2C细胞少于Ⅰ～Ⅱ级 ,≥ 5C的细胞超过 2 0 % ,各组间DNA倍体参数之间差异有显著性 (P <0 .0 1)。瘤细胞核面积、周长和形状因子等参数在Ⅰ～Ⅳ级间差异都具有显著性 (P <0 .0 1)。随访资料中FuhrmanⅠ～Ⅱ级复发及死亡数为 2 / 16 ,而Ⅲ～Ⅳ级为 8/12 ,两组比较 ,复发转移及死亡率差异有显著性 (P <0 .0 1)。平均DNA倍体和细胞核形态参数在健存组与复发死亡组之间差异有显著性 (P <0 .0 1)。结论 :提示肾细胞癌Fuhrman分级Ⅰ～Ⅱ级预后较好 ,Ⅲ～Ⅳ级预后差。用图像细胞术进行细胞核DNA倍体及核形态参数测定 ,对肾细胞癌预后判断有应用价值。

Objective:To determine the prognostic value of DNA ploidy and nuclear morphometry,and its relations to nuclear grading in renal cell carcinoma.Methods:Pathological grading were done in 47cases of renal cell carcinoma in accordance with the system proposed by Fuhrman et al.Feulgen staining were performed in the tumor histological slides,and the technique of image cytometry was used to quantitate nuclear DNA ploidy and nuclear morphological parameters.The results combined with the data of clinical follow up were analyzed.Results:The mean DNA ploidy in grade Ⅰ～Ⅱ was mainly 2C,≥5C cells less than 10%;the 2C cells in grade Ⅲ～Ⅳ were lower than in grade Ⅰ～Ⅱ,≥5C cells were more than 20%.Among the four grades DNA ploidy were statistically different( P <0.01).There were significant differences in the nuclear area,perimeter and shape factor among the groups of grade Ⅰ～Ⅳ( P <0.01).According to the data of clinical follow up,the number of relapse,metastasis and death in the group of Fuhrman grade Ⅰ～Ⅱ (2/16) was statistically lower than in the group of Fuhrman grade Ⅲ～Ⅳ(8/12)( P <0.01).There were significant differences in DNA ploidy and nuclear morphological parameters between groups of the living and dead ( P <0.01).Conclusion:Our research suggests that Fuhrman grade Ⅰ～Ⅱ show a favorable prognosis while grade Ⅲ～Ⅳ show a poor one in patients with renal cell carcinoma.The measurment of DNA ploidy and nuclear morphological parameters by image cytometry (ICM) have an important value for predicting the prognosis of renal cell carcinoma.