DEOXYRIBONUCLEIC-ACID CONTENT AND SURVIVAL RATES OF PATIENTS WITH TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

In 127 patients with urothelial carcinoma of the bladder the ploidy, d eoxyribonucleic acid (DNA) heterogeneity and counts of cell cycle phas es in the tumor were analyzed by means of single cell DNA cytophotomet ry with the intention of finding new prognostic factors in addition to those already known (stage and grade). Patients were followed for 1 t o 9 years. The results of the DNA analyses were related to the tumor c ategories, histopathological grading of the tumor and clinical course. Tumors were histologically classified as grade 1-DNA frequency peaks in the diploid range, grade 2- heterogenous DNA distribution patterns, and grade 3-73% aneuploid and 27% tetraploid DNA values. The prolifer ation rate of the tumor cells was statistically greater in cases of hi stological grades 2 and 3 malignancy than in grade 1 malignancy. There was also a positive correlation between tumor stage and DNA ploidy. T he cell lines were aneupolid in 38% of the patients with stage pT1, 64 % with stage pT2 and almost 85% with stage pT3 tumors. A significant c orrelation was found between the results of DNA cytophotometry and the clinical course of the disease. Patients with diploid tumor cell line s had no metastases and no local tumor progression for up to 9 years, whereas patients with multiple aneupolid tumor cell lines suffered rec urrence and local tumor progression within 6 to 36 months. On the aver age, the patients died of the tumors 26 months after primary diagnosis . The difference in tumor recurrence and in tumor progression between patients with aneuploid and diploid tumors was highly significant (p < 0.001). The prognosis for patients with grade 1 tumors is good, where as it is unfavorable in the case of grade 3 tumors. For these 2 groups DNA ploidy affords no additional prognostic information. Grade 2 tumo rs, on the other hand, are heterogeneous in respect to DNA ploidy, alt hough they exhibit the same degree of histomorphological differentiati on. These tumors can be subclassified as aneuploid (biologically aggre ssive) and diploid or tetraploid (biologically less aggressive). In te rms of multivariate Cox regression analysis, DNA ploidy compared with grade and tumor stage was the strongest predictor of survival.