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I.はじめに
星細胞系腫瘍(astrocytic tumors)は一般的に予後不良な脳腫瘍であるが,その悪性度の評価や予後の推測は,いまだ病理組織像に大きく依存しているのが現状である.病理組織分類は,細かく分類され診断学的には極めて有川である19,32).しかしながら,同一組織群に分類されるにもかかわらず,患者の予後に大きな差が見られることもまれではなく,悪性度の評価を形態学的手法のみに頼ることについては問題がある.現在,腫瘍の生物学的性状をより直接的に反映するマーカーの検索が精力的に行われている理由はここにある.頭蓋という閉鎖された腔内では,腫瘍細胞の増殖能が患者の予後を左右する重要な因子の一つであり,astrocytic tumorsにおいても,組織像に加えて,増殖能を定量的に計測することの重要性が指摘されており,モノクローナル抗体やflowcytometryを用いた悪性腫瘍の成長解析が盛んに行われるようになっている8,15,18,23,25,26,28).DNA合成に必要な酵素の一つであるDNA polymeraseδの補助因子である4)PCNA(proliferating cell nuclear antigen)は,増殖期にある細胞の核内に特異的に発現するといわれており2,3,5,31),腫瘍細胞の増殖能を反映するマーカーとして最近注目されている6,7,10,13,20,21,29,30).脳における代表的腫瘍であるastrocytic tumorsにおいて抗PCNAモノクローナル抗体を用いてPCNAの標識率(labeling index:LI)を測定し,その臨床的有用性を十灸討するとともに病理組織像と対比した.
PCNA (proliferating cell nuclear antigen) is said to be present specifically in the nucleus of proliferating cells. The PCNA labeling index (PCNA LI) of astrocytic tumors was measured and compared with histological types or prognosis. The specimens from 44 patients were fixed in a 10% formalin solution, and embedded in paraf-fin. The 3 pm-sections were stained immunohistochemi-cally with anti-PCNA monoclonal antibody (PCIO, Novocastra) using an ABC method. The percentage of PCNA-positive-cells was determined by counting 2000 cells, and identified as PCNA LI.
All of the PCNA-positive-cells showed diffuse nucleo-plasmic staining. The averages of PCNA LIs in each pathological type we Although differences in averages of PCNA LIs among pilocytic, gemistocytic, fibrillary astrocytoma were not significant, there was a significant difference between anaplastic astrocytoma and glioblastoma. The relationship between PCNA LIs and the prognoses for 43 patients was studied. Forty-three patients were classi-fied into 3 groups (over 22%, 7 to less than 22%, and less than 7%) according to PCNA LIs. The survival data in the 3 groups were analyzed, and differed significantly in the survival rates. Furthermore, twenty-three patients of anaplastic astrocytoma and glioblastoma were classified into two groups (over 22% and less than 22%). Likewise, the two groups differed significantly.
In summary, pathological type and prognosis were closely related to PCNA LI in astrocytic tumors. There-fore, we thought measurement of PCNA LI would make it more possible to analyze clinically the proliferating activity of astrocytic tumors, and to care for patients more effectively.re calculated and evaluated statisti-cally.
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