Prognostic significance of flow cytometric deoxyribonucleic acid analysis for patients with superficial bladder cancers: A long-term follow-up study

Flow cytometric DNA ploidy analysis for human bladder cancers may provide s ignificant diagnostic and prognostic potential. We have previously reported that combined use of histologic and flow cytometric parameters may offer a dditional information regarding the clinical outcome for bladder cancer pat ients. However, the evaluation included both superficial and muscle-invasiv e tumors. In the present manuscript, we present our study on whether flow c ytometric determination yields significant prognosticators beyond the class ical histologic evaluation only in the patient with superficial bladder can cer. A total of 217 patients with untreated bladder cancer were evaluated, using fresh bladder tumor specimens. Tumor grading (grade 1, 2, and 3) and stage (pTa + pT1a and pT1b) served as the histologic prognostic parameters. Multiple flow cytometric parameters assessed included DNA index, percentag e S-phase cells, percentage GUM-phase cells, and hypertetraploid cell prese nce. Multivariate survival analysis was performed using the SAS proportiona l hazard regression procedure to study statistical individual prognostic va lues of both the histologic and the flow cytometric parameters. Clinical fo llow-up of more than 60 months was required, with the mean follow-up being 116.3 +/- 18.6 months. Hypertetraploid cell presence was the single most im portant prognostic factor (p < 0.01; risk ratio: 14.3), with the second bei ng tumor grade (p < 0.05; risk ratio: 4.6). No other parameters, including tumor stage, the DNA index, and cell phase fractions, contributed to the mo del. These results indicate that hypertetraploid cell presence found by flo w cytometric determination may provide additional information regarding the clinical outcome for superficial bladder cancer patients, and can be used as an indicator for decision making in treatment of superficial bladder can cer patients.