Proliferative activity of esophageal carcinomas and their lymph node metastases : Comparison using argyrophilic nucleolar organizer region staining

Background: Many reports have concluded that quantification of the argyrophilic nucleolar organizer regions (AgNORs) measures proliferative activity and is a prognostic indicator in malignant disease. This retrospective study set out to evaluate the relationship between the AgNORs of the primary tumors and those of lymph node metastases in esophageal carcinoma. Methods: Using a one-step silver staining technique, AgNORs were counted in surgical specimens from 54 patients with squamous cell carcinomas. Results: The AgNOR scores of the lymph nodes metastases were significantly lower than those of the primary tumor (P = 0.0001). In 53 of 54 cases (98%), the AgNOR scores in the nodal metastases were lower than those of the primary tumor. The survival of 22 patients with AgNOR scores ≥4.0 for the primary tumor was significantly less than that of 32 patients with AgNOR scores <4.0 for the primary tumor (P = 0.0014). Conclusions: The AgNOR score of the lymph node metastases had no prognostic significance. The AgNOR score of esophageal primary cancer reflects the prognosis of patients. Scores for lymph node metastases were lower and did not reflect prognosis. The lower score in the lymph node metastases may result from the antitumor activity of macrophages in the lymph nodes.