STUDIES ON BLADDER CANCER BY FLOW CYTOMETRY
II. Evaluation of Prognosis and intravesical Recurrence of Bladder Cancer Based on Flow Cytometric DNA Analysis
1987 Volume 78 Issue 2 Pages 227-231
Details
1987 Volume 78 Issue 2 Pages 227-231
DNA histograms were measured by flow cytometry (FCM) for 100 bladder tumors (transitional cell carcinoma) of 94 patients using the rapid detergent method with propidium iodide. The patients were followed clinically for 3 months to 5 years. The mean follow-up time was 23.3±16.0 months. The tumors were classified as diploid or DNA aneuploid. The degree of ploidy was determined by DNA index (DI), the ratio of peak channel number of the G1 compartment of the tumor cells to that of the diploid standard, and the existence of more than one aneuploid cell clone (clonal heterogeneity) was considered.
1) During the follow-up period, seventeen patients died; 8 of them died of bladder cancer, and 9 of other causes. Five patients were alive with cancer at the advanced stage of bladder cancer, and other 72 patients were alive in a tumor free state. FCM DNA analysis showed that 24 tumors were diploid and 76 tumors were DNA aneuploid. Thirteen patients showed the existence of clonal heterogeneity. Values of DI were distributed from 1.00 to 4.08.
2) All tumors of the patients who died of bladder cancer and patients who were alive with cancer at the advanced stage showed DNA aneuploidy. Namely, all tumors of the poor prognosis patients showed DNA aneuploidy. Patients with more than one aneuploid cell clone showed a poorer prognosis rate (38.5%) than those with only one aneuploid cell clone (13.1%). From these results, it is clear that DNA aneuploidy and the existence of clonal heterogeneity were markers of poor prognosis.
3) To estimate the value of FCM DNA analysis as a marker of intravesical recurrence, thirty-one cases of newly detected superficial bladder tumors were studied. No correlations were observed between tumor recurrence and grade, nor between recurrence and ploidy.
4) It is suggested that, to estimate the malignant potential of bladder tumor, FCM DNA analysis is valuable and ought to have an influence on the treatment of patients with bladder cancer. Considering its rapidity, especially as the preoperative examination of T1, T2 bladder tumors, FCM DNA analysis is a good method to determine whether only the bladder preserving operation is enough or not. We think that tumors with DNA aneuploidy or more than one aneuploid cell clone need more aggressive thearpy than diploid ones.
