Prognostic significance of bromodeoxyuridine high labeled bladder cancer measured by flow cytometry: does flow cytometric determination predict the prognosis of patients with transitional cell carcinoma of the bladder

[DNA ploidy determination with flow cytometry, Ki-67 index and overexpression of p53 protein in 121 T1 superficial bladder carcinomas. Retrospective studies. Part II: Prognostic value and usefulness in the indication for prophylactic treatment with BCG]

OBJECTIVE

Evaluate the utility of Ki-67 label index, p53 expression and flow cytometry-DNA ploidy in the selection of groups to be treated with prophylactic BCG and the prognostic value compared with the classic variables (grade, lymphatic permeation, multiplicity, volume, primary).

MATERIAL & METHOD

121 superficial bladder tumors T1. 10% Cut-off level for Ki-67 and p53. Aneuplody is defined as a tumor with DNA index different of 1 or more than 20% in G2-M phase. 71 (58.7%) received BCG.

RESULTS

In uni and multivariate analysis positivity to Ki-67 is correlated with recurrence. Progression is correlated with lymphatic permeation (p .0003), volume (p .016), ploidy (p .022) and positivity to p53 (p .007). In multivariate analysis, volume and positivity to p53 are independent variables. None were of utility to prevent recurrence, but Ki-67 positive or aneuploid treated tumors had less progression (p .025 and p .009 respectively). The p53 negative treated tumors had less progression too.

CONCLUSIONS

Only Ki-67 is correlated with tumoral recurrence. P53 and tumor volume are correlated with stage progression. If the results are confirmed with bigger series, the Ki-67 positive and/or aneuploid tumors would obtain benefits of prophylactic treatment with BCG.

Bladder tumor markers: need, nature and application. 1. Nucleus-based markers

Urothelial tumors are common: their diagnosis and long-term management represent a large part of most urologists' workload. The majority of such tumors are 'superficial' and are mostly managed by repeated cystoscopic surveillance and treatment. A smaller but significant group of patients either start with, or subsequently progress to, more invasive disease, thus requiring an alternative and more invasive treatment. Maximizing the benefit/risk ratio of the diagnosis and the various treatment options of bladder tumors requires the availability of a reliable tumor marker. The concept of tumor markers encompasses the utilization of any detectable deviation from normality that is indicative of neoplasia. For bladder cancer, most of these markers are present in urine. In this part of the review we examine, from the clinician's point of view, the literature verdict on older techniques such as cytology and cytometry, as well as the current status of new nucleus-based tests such as P53, telomerase, NMP22 and Ki67.

Prognostic significance of nuclear DNA content and S-phase fraction by flow cytometry in primary papillary superficial bladder cancer

This study is aimed at determining the usefulness of nuclear DNA content and S-phase fraction (SPF) to predict tumor recurrence in papillary superficial bladder cancer. Tumor DNA content and SPF were measured by flow cytometry on formalin-fixed, paraffin-embedded tissue from 199 newly diagnosed pTa/pT1 transitional cell carcinomas of patients enrolled into a multicenter prospective study from 1990 to 1992. The follow-up extended up to March 1994, and, at last follow-up, 122 (61.3%) patients have experienced at least one recurrence. After exclusion of 34 cases, whose coefficient of variation exceeded 8%, 131 (79.4%) tumors were diploid, and 34 (20.6%) were aneuploid. There was no association between tumor DNA content and time to first recurrence. Diploid tumors with low SPF (< 11%) tended to have a longer recurrence-free survival (RFS) than those with high SPF, but this difference did not reach statistical significance (P = .2833). SPF in aneuploid tumors did not add any new information. Aneuploidy was associated with higher stage (P < .001), poorer grade (P < .002), multifocality (P = .028), Her-2/neu (P = .021), and p53 (P = .033) expression. High SPF correlated with higher stage (P = .066) and higher grade (P = .025). This study shows that DNA-ploidy and SPF measured on a single superficial bladder cancer specimen are not predictive of tumor recurrence. The frequent multifocality of the disease may explain, in part, these findings.

Analysis of cell growth with biparametrical flow cytometry in bladder cancer as prognostic evaluation

The aim of this work is to compare a biparametrical analysis of DNA using flow cytometry with the monoparametric approach. We analysed 71 samples coming from neoplastic tissue and from non-neoplastic tissue. We compared the average uptake of BrdU (22.37%) with the traditional prognostic parameters. Even if in some cases we found a certain correlation between the traditional prognostic parameters and the average uptake of BrdU, the results are still not encouraging. A final answer can only be supplied after analysing a greater number of cases and after a suitable follow-up period.

Indici di proliferazione (Ki 67, TLI) ed espressione della p53. Introduzione: Proliferation indices (Ki 67, TLI) and p53 expression. Introduction

Histologic and pathologic findings are the most common and useful prognostic factors in transitional cell cancer of the bladder. Thus, clinicians know their peculiar limits very well. The Authors report the results of a literature review about an oncogenic-derivative protein (p53) and about indices of proliferation Ki 67 and TLI, which are frequently studied in bladder cancer.

Use of bromodeoxyuridine, proliferating cell nuclear antigen, and nucleolar organizer regions in the multiparametric assessment of proliferating potency in cervical intraepithelial neoplasia

The authors analysed of the proliferative activity of intraepithelial neoplasia of the cervix utilizing the labeling index of monoclonal antibody to Bromodeoxyuridine (BrdU) or proliferating cell nuclear antigen (PCNA), and the number of Nucleolar organizer regions (Ag-NOR). The BrdU labeling index (B.L.I.) for normal squamous epithelium, mild dysplasia, and moderate dysplasia were significantly lower than for severe dysplasia or carcinoma in situ. The PCNA labeling index (P.L.I.) for normal squamous epithelium, mild dysplasia, and moderate dysplasia were significantly lower than for severe dysplasia or carcinoma in situ. The number of Ag-NOR dots of normal squamous epithelium and mild dysplasia were lower than those of severe dysplasia or carcinoma in situ. There are significantly positive correlations of the B.L.I., P.L.I., and the number of Ag-NORs in cervical intraepithelial neoplasia.

Indici di proliferazione (Ki 67, TLI) ed espressione della p53. Esperienza personale: Proliferation indices (Ki 67, TLI) and p53 expression. Personal experience

The Authors report their experience on the study of urothelial bladder cancer by determining the overexpression of p53, DNA-content by flow-cytometry, Ki 67, TLI and cytofluorimetric S-phase in 81 patients. Ki 67, DNA content and p53 overexpression are statistically related with histologic grade, unlike TLI and S-phase. TLI, overexpression of p53 and Ki 67 are statistically related with stage, whereas ploidy and S-phase do not show any relation with stage. The Authors discuss these findings.

Flow cytometric bromodeoxyuridine/deoxyribonucleic acid bivariate analysis for predicting tumor invasiveness of upper tract urothelial cancer

We previously reported that flow cytometric bromodeoxyuridine/deoxyribonucleic acid (DNA) bivariate analysis can provide important information on the malignant potential of bladder cancer. Therefore, in the current study we further evaluated upper tract urothelial tumors to clarify whether DNA/bromodeoxyuridine bivariate analysis can provide additional prognostic information on patients with upper tract urothelial tumor. A total of 43 upper tract urothelial tumors that were resected by nephroureterectomy was analyzed. Flow cytometric DNA ploidy and bromodeoxyuridine labeling were determined by an in vitro bromodeoxyuridine labeling method. DNA diploid tumors were associated with an 85.9% 3-year survival rate compared to 36.5% for DNA aneuploid tumors. On the other hand, 11 high bromodeoxyuridine labeled tumors demonstrated a 16.4% 3-year survival rate compared to 82.4% for those with low bromodeoxyuridine labeled tumors. Multivariate survival analysis using the Cox proportional regression model was performed to identify the most informative factors for prognosis, with the single most important factor being histological tumor stage. Nearly as important and the next factor to be chosen was tumor grade, followed by bromodeoxyuridine labeling index status. DNA ploidy status did not influence clinical outcome. Thereafter, when actuarial 3-year survival rates according to the bromodeoxyuridine labeling index status in grade 3 tumors were estimated, 68.4% and 16.7% 3-year survival rates were observed in cases of low and high bromodeoxyuridine labeling index tumors, respectively. These results indicate that flow cytometric bromodeoxyuridine/DNA bivariate analysis may be useful in dividing patients with grade 3 upper tract urothelial carcinoma into 2 different prognosis groups.