THE USE OF DNA-CYTOMETRY FOR THERAPY PLAN NING IN SUPERFICIAL CARCINOMA OF THE URINARY-BLADDER

The results of DNA cytometry - along with clinical stage and histopath ologic tumor data - are the most important prognostic parameters in su perficial carcinoma of the urinary bladder. The aim of the present stu dy was to prove if and to which extent DNA parameters yield an objecti ve and valid criterion for the therapeutic decision and prognosis. DNA content was determined by flow cytometry and static DNA cytometry in parallel. The measurements were prospective in 51 patients (1982-1988) with a clinical follow-up of at least 5 years. In another 75 patients (1987-1990) whose clinical course was known, we performed retrospecti ve measurements. We found histological grading to correlate significan tly with the nuclear DNA content, the DNA index (DI), the 5c-exceeding -rate, and DNA malignancy grading (MG) by Bocking. The DI showed signi ficant correlation with the recurrence rate of the tumors. Summarising the three cytometric parameters mentioned above permits a subdivision of the tumors in ''low risk'' and ''high risk'' cases, which is more powerful than histopathologic grading or therapeutical groups. Based o n the results of this study, we developed a concept for cytometrically stratified application of local chemotherapy in superficial urinary b ladder carcinomas. This concept ist currently being checked in a multi centric randomised phase-III study. The results of 81 patients (51 wit h low risk tumors) who had had a clinical follow-up of one year reveal ed the prognostic relevance of the DNA parameters.