PROGRESSION AND SURVIVAL IN TRANSITIONAL CELL BLADDER-CANCER - A COMPARISON OF ESTABLISHED PROGNOSTIC FACTORS, S-PHASE FRACTION AND DNA PLOIDY

DNA flow cytometric (FCM) data, histological features and clinical stage of bladder tumours in 222 patients were related to outcome during a mean follow-up of 10 years. Aneuploidy was detected in 82 (37%) of tumours and 140 (63%) were diploid. Intratumour heterogenity of DNA ploidy was found in 27% of 30 cases. Aneuploidy and high S-phase fraction (SPF) were related to clinical stage, histological grade and papillarity (P < 0.0001). Aneuploidy (P < 0.0001) and high SPF (P < 0.0001) predicted metastasis to pelvic lymph-nodes and to distant sites. T category (P < 0.0001), SPF (P < 0.0001), histological grade (P < 0.0001), papillarity (P = 0.0021), DNA aneuploidy (P = 0.0094) and G2 fraction (P = 0.0340) predicted cancer-related survival. Multivariate analysis showed DNA aneuploidy as the most important predictor of progression in T category (P = 0.0003) and T category was the most important predictor of lymph-node involvement (P = 0.0083) and metastasis (P = 0.0015), followed by FCM parameters. In Ta-T1 tumours SPF predicted progression independently (P = 0.0153). FCM offers more accurate prognostic information in Ta-T1 tumors than conventional methods. In invasive tumours, FCM offers quantitative prognostic information in terms of pelvic lymph-node metastasis and metastasis to distant sites.