Cyclin/proliferation cell nuclear antigen immunohistochemistry does not improve the prognostic power of Dukes' or Jass' classifications for colorectal cancer

NEOPTOLEMOS, J. P.
OATES, G. D.
NEWBOLD, K. M.
ROBSON, A. M.
McCONKEY, C.
POWELL, J.

Academic Department of Surgery, City Hospital, Dudley Road, Birmingham, *Department of Surgery, Birmingham General Hospital, Steelhouse Lane, Birmingham, **South Warwickshire Hospital, Lakin Road, Warwick, ***CRC Trials Unit, University of Birmingham and ****Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
Correspondence to: Professor J. P. Neoptolemos, Department of Surgery, W4, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK
Presented to the tripartite meeting `Coloproctology' in Sydney, Australia, October 1993
Paper accepted 23 June 1994

British Journal of Surgery 82(2):p 184-187, February 1995.

Immunohistochemistry of cyclin/proliferation cell nuclear antigen (PCNA) is an attractive alternative to tumour cell proliferation activity determined by flow cytometry which has been shown to be independently predictive of survival in patients with colorectal carcinoma and to enhance Dukes' classification. Dukes' and Jass' histopathological classifications were determined in 91 patients who had undergone curative resection for cancer of the colon (n equals 51) or rectum (n equals 40) and followed up for a minimum of 10 years. PCNA immunohistochemistry was possible in 79 tumours. Univariate analysis revealed that Jass' (P less than 0.0001) and Dukes' classifications (P less than 0.0002) were powerful predictors of survival but that the PCNA index had little prognostic power (P equals 0.4). Multivariate analysis of both classifications showed similar predictive power and the PCNA index improved the prediction of survival when used with either classification for patients with colon cancer (chi² equals 5.3, 1 d.f., P equals 0.02 for each combination). The PCNA index, however, was not predictive for rectal cancer. Patients with the lowest PCNA index had the worst prognosis.