SYSTEMATIC HETEROGENEITY AND PROGNOSTIC-SIGNIFICANCE OF CELL-PROLIFERATION IN COLORECTAL-CANCER

The prognosis of colorectal cancer has not significantly changed durin g the last 30 years. While evaluation of tumour cell proliferation may provide prognostic information, results obtained so far have been con tradictory. Heterogeneity in tumour cell proliferation may explain the se contradictions. With in vivo injection of iododeoxyuridine (IdUrd), estimation of labelling index (LI), S-phase transit time (T-s) and po tential doubling time (T-pot) may be performed from a single sample. A total of 109 colorectal cancers were studied after in vivo injection of IdUrd before surgical removal. From each cancer, four to eight samp les were processed for both flow cytometrical (FCM) and immunohistoche mical (IHC) visualization of IdUrd incorporation. LI/IHC was morphomet rically quantified at both the luminal border and the invasive margin of these tumours. LI was significantly higher at the luminal border co mpared with the invasive margin, although they were correlated with ea ch other. Using combined IMC and FCM methods, rapidly growing colorect al cancers (high LI and/or low T-pot) showed an increased survival (si gnificant for LI at the invasive margin and for T-pot at both the inva sive margin and the luminal border) in the entire unselected material and for radically removed Dukes' B tumours. FCM data alone did not dis criminate for survival, with the exception of T-s in diploid and radic ally removed Dukes' B tumours.