A PROGNOSTIC MODEL OF SURVIVAL IN SURGICALLY RESECTED SQUAMOUS-CELL CARCINOMA OF THE LUNG USING CLINICAL, PATHOLOGICAL, AND BIOLOGIC MARKERS

The biologic behavior of tumoral cells plays a significant role in the progression of the neoplasia, because 30 to 35% of patients with Stag e I squamous cell carcinoma relapse. The present study was designed to determine whether age, pathologic parameters, DNA ploidy, and a cell proliferation index (the area of nucleolar organizer regions, AgNOR), could be used to predict survival in patients who undergo resection fo r limited squamous cell carcinoma of the lung. For histopathologic ana lysis, the parameters of histologic grading, pleural involvement, vasc ular invasion, and residual disease were considered. The cell prolifer ation index was evaluated by mitotic index, AgNOR quantification, and DNA ploidy by means of digital image analysis. Fifty-two patients (med ian age, 60 yr +/- 8.6 yr) were staged according to the TNM staging sy stem. Cox univariate analysis showed that stage, residual disease, vas cular invasion, histologic grading, DNA ploidy, and AgNOR were signifi cant predictors of survival. Many of the univariate predictors of canc er death, however were eliminated when Cox multivariate models were co mputed. The variable that exhibited the most robust predictive value f or overall survival was AgNOR We conclude that measurement of cell pro liferation might serve as a prognostic marker in squamous cell carcino ma of the lung.