EVALUATION OF THE ARGYROPHILIC NUCLEOLAR ORGANIZER REGION, NUCLEAR-DNA CONTENT AND MEAN NUCLEAR-AREA IN TRANSITIONAL-CELL CARCINOMA OF BLADDER USING A QUANTITATIVE IMAGE ANALYZER

To search for reliable parameters that reflect the biological potentia l of bladder cancer, the argyrophilic nucleolar organizer region (AgNO R), nuclear DNA content and mean nuclear area (MNA) were studied in pa raffin-embedded materials of 75 primary transitional cell carcinomas ( TCCs) using a quantitative image analyzer, and were also compared with histological findings and prognosis. The AgNOR parameters studied wer e the mean AgNOR count (C-AgNOR) and the percentage of cells exhibitin g more than 4 AgNOR dots within nuclei (P-AgNOR), whereas the DNA para meters were the 2c deviation index (2cDI) and 5c exceeding rate (5cER) . These 5 parameters significantly correlated with the histological gr ade (p < 0.0001, respectively). Similarly, these 5 parameters correlat ed with the histological stage, but the correlation was higher in 2cDI and ScER (p < 0.0001, respectively) in comparison with the AgNOR para meters and MNA. Using univariate analysis, the prognostic relevance wa s noted in all but P-AgNOR. The ScER value could discriminate histolog ical grade-II tumors in relation to prognosis, whereas the remaining p arameters could not. In addition, the significant difference between n oninvasive and invasive tumors was noted in 2cDI and ScER (p < 0.05, r espectively), but not in C-AgNOR, P-AgNOR and MNA. These results sugge st that (i) 2cDI and ScER exhibit superiority over the AgNOR parameter s and MNA in predicting survival, and (ii) in histological grade-II tu mors, evaluation of the ScER value is most important when predicting s urvival as well as judging the necessity for further aggressive treatm ent in patients with TCCs of the bladder.