Value of flow cytometric analysis of nuclear deoxyribonucleic acid as a prognostic parameter in transitional cell carcinoma of the upper urinary tract

Shin, Ki Yong; Woo, Young Nam

Abstract

To investigate the clinical significance and application of DNA ploidy pattern in transitional cell carcinoma of the upper urinary tract, a total of 36 patients underwent flow cytometric analysis of DNA ploidy from paraffin-embedded tumor tissues. Diploidy presented in 28 patients(77.8%) and aneuploidy in 8 patients(22.2%). There was excellent correlation between histologic grade and DNA ploidy(p<0.005), but DNA ploidy pattern was not significantly associated with tumor stage. The mean percentage of S-phase fraction was higher in high grade, aneuploid group compared to low grade, diploid group respectively. And this flow cytometric parameter in patients with tumor progression was significantly higher than in patients without progression(p<0.025). Three-year disease-free survival rate was 64% in diploid group, but all patients with aneuploid pattern showed subsequent vesical neoplasms or distant metastases within follow-up duration of 27 months. Actuarial survival was influenced by tumor grade, stage and DNA ploidy. In patients with high stage tumor, the actuarial survival rate of patients with aneuploid pattern was significantly lower than patients with diploid pattern (p<0.005). And the actuarial survival rates between aneuploid and diploid group in patients with low stage tumor were different statistically(p<0.001). These data suggest that flow cystometric DNA analysis in patients with transitional cell carcinoma of the upper urinary tract may provide a useful prognostic information in addition to tumor stage and grade. And DNA ploidy pattern may be a useful parameter to identity high risk group in patients with same stage, especially with low stage transitional cell carcinoma of the upper urinary tract.