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Selective nuclear morphometry as a prognostic factor of survival in
renal cell carcinoma
J.M. Monge1, J.F. Val-Bernal2, L. Buelta2, L. García-Castrillo3
and L. Asensio1
Departments of 1Urology, 2Anatomical Pathology, and 3Emergency
Medicine, Marqués de Valdecilla University Hospital, University of
Cantabria School of Medicine, Santander, Spain
Offprint requests to: J. Fernando
Val-Bernal, MD, PhD, Departamento de Anatomía Patológica,
Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla 1,
39008 Santander, Spain. Fax: 34-942-201903
Summary. In the present study,
we sought to determine the predictive value of selective nuclear morphometry
(SNM) for patient outcome in renal cell carcinoma (RCC). Tumor samples of
140 renal adenocarcinomas diagnosed and treated with radical nephrectomy
and hilar lymphadenectomy between 1970 and 1988 with a minimum follow up
of 5 years in all the cases were studied by SNM. The morphometric analysis
was performed in the most malignant tumor selected zone. Selection was based
on cytological criteria including nuclear grade. Nuclear morphometric features
analyzed were: area, perimeter, major diameter, major and minor diameter
of the equivalent ellipse, volume of the equivalent ellipse and sphere,
circumference diameter, and shape factors. The results showed that in the
selected zone tumor nuclei were larger than in the zones selected at random.
There was an inverse correlation between morphometric parameters and survival
and a direct one between tumoral grade and stage. Tumors of the long-term
survival group of patients presented nuclei with smaller morphometric measurements
than tumors of short term survival group, with significant differences between
them (p<0.05). In the survival analysis carried out by the Kaplan-Meier
method significant differences existed between different groups formed from
break point for: area, perimeter, major diameter, major and minor diameter
of the ellipse, volume of the ellipse and sphere, circumference diameter
and perimeter shape factor. In the multivariate analysis carried out by
the Cox method, the feature with the most predictable value related to survival,
was the tumor stage. Morphometric value with the highest punctuation in
the test was major nuclear diameter. The rest of the morphometric values
(except elliptic shape factor and elongation factor) were also significant
but they did not improve prognostic information of the major nuclear diameter.
SNM offers a useful aid in a more objective grading of RCC. Multi-variate
Cox analysis revealed additional value of karyometry to tumor stage. SNM
can be a useful tool for stratification of patients with RCC. Histol.
Histopathol. 14, 119-123 (1999)
Key words: Renal cell carcinoma,
Morphometry, Prognosis
DOI: 10.14670/HH-14.119
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