Characterization of squamous cell bladder tumors by flow cytometric deoxyribonucleic acid analysis: a report of 100 cases

Ploidy and Proliferation Evaluated by Flow Cytometry. An Overview of Techniques and Impact in Oncology

Flow cytometric methods for the assessment of nuclear and chromosomal DNA content and of cell proliferation (including methods based on pulse-chase of bromodeoxyuridine and on monoclonal antibodies against nuclear oncoproteins and proliferation-associated antigens) are illustrated by examples and analyzed critically. The impact of most of these techniques for the study of human solid tumors, with exception of nuclear DNA content evaluation, appears still limited. In particular, new studies of cell lines and clinical material from human tumors using new proliferation markers and multiparameter flow cytometry are necessary to solve a considerable number of methodologic and scientific problems.

Proliferating cell nuclear antigen (PCNA) overexpression and microvessel density predict survival in the urinary bladder carcinoma

OBJECTIVE

To study proliferating cell nuclear antigen (PCNA) over expression and angiogenesis with their relationship to tumor parameters in squamous cell carcinoma of the urinary bladder in patients who underwent radical cystectomy.

PATIENTS AND METHODS

The mean age of the patients was 53.53 years (range; 29-70 years) and the males were 98 of 154. Sections from paraffin embedded tissues were retrieved and stained with antibodies against PCNA for proliferation and CD34 for angiogenesis using immunohistochemical technique. Fisher's exact test was used to evaluate the relationship between categorical variables and the Kaplan-Meier procedure was used to assess survival outcomes. The Cox regression model was used for multivariate analysis.

RESULTS

The median follow up period was 65 months. microvessel density (MVD), PCNA, tumor grade, P-stage, DNA ploidy, lymph node status had a significant impact on the 5-year survival of patients in univariate analysis. In Cox proportional hazard model, MVD, PCNA, DNA ploidy and stage sustained their significant impact on survival of the patients.

CONCLUSIONS

MVD, PCNA, DNA ploidy and stage are independent prognostic factors in patients with squamous cell carcinoma of the urinary bladder.

Prognostic value of angiogenesis in schistosoma-associated squamous cell carcinoma of the urinary bladder

OBJECTIVES

To evaluate angiogenesis as a prognostic marker in squamous cell carcinoma of the urinary bladder in 154 patients who underwent radical cystectomy.

METHODS

The tumors from 98 men and 56 women (mean age 46.3 +/- 8.4 years) were examined. Vessels were stained using an antibody to the platelet endothelial cell adhesion molecule CD31. Microvessels were counted in active areas of angiogenesis within the tumors. Microvessel density (MVD) was quantified using the mean of three counts. Age, sex, tumor grade and stage, DNA ploidy, and MVD were evaluated in relation to outcome. Univariate and multivariate analyses of survival were performed.

RESULTS

The median follow-up period was 63 months. The overall 5-year survival rate was 56 +/- 4.1. Tumor grade, tumor stage, DNA ploidy, and MVD had a significant impact on the survival of patients in univariate analysis. The 5-year survival rate in patients with a low MVD (11 or less) was 68.1% compared with 50.4% for those with a high MVD (greater than 11; P <0.01). Men had more vascular tumors than did women. Also, high-grade tumors had significantly higher vascular counts. In a Cox proportional hazard model, tumor angiogenesis sustained its significant impact on survival of the patients in addition to tumor stage and DNA ploidy.

CONCLUSIONS

These findings suggest that angiogenesis and DNA ploidy are independent additional prognostic factors in patients with squamous cell carcinoma of the urinary bladder.

[Molecular biology in bladder cancer]

Progress of molecular biology with regard to etiopathogeny of tumours in general, and cancer of the bladder in particular, is taking place at such a vertiginous pace that practising urologists find themselves overwhelmed in terms of their ability to learn and keep updated in so complex a subject. The understanding of certain molecular factors with critical influence on the formation, growth and progression of a tumour of the bladder, is forcing us to make unbiased assessments on the role they will play in the evolution and survival of this neoplasia. It is anticipate they will be much more reliable than traditionally established morphological factors such as grade and stage. We also include a literature review with an analysis and elucidation of the role played by oncogenes, tumor suppressor genes, vascular density markers, telomerase etc., in the formation and growth of cancer of the bladder and their likely relationships with already established clinico-pathological factors.

Primary adenocarcinoma of the urinary bladder: a report of 185 cases

OBJECTIVE

To evaluate the outcome after the treatment of primary non-urachal vesical adenocarcinoma and to determine the significant prognostic factors.

PATIENTS AND METHODS

The records of 185 patients with vesical adenocarcinoma were reviewed. The pathological evaluation included the determination of pathological stage, tumour grade, presence or absence of mucin and its location, evidence of bilharzial infestation and flow-cytometric DNA analysis. The mean follow-up of the treated patients was 3.1 years. Disease-free survival was estimated and the results correlated with patient and tumour characteristics (univariate analysis). Cox's proportional hazards analysis was used to determine prognostic factors.

RESULTS

The overall 5-year disease-free survival was 55%; only three factors had a significant impact on survival, the tumour pathological stage and grade, and lymph node involvement.

CONCLUSIONS

Radical cystectomy remains the only satisfactory treatment option for primary vesical adenocarcinoma. Tumour stage, grade and lymph node involvement are the only significant prognostic factors.

Primary nonurachal adenocarcinoma in the bilharzial urinary bladder: deoxyribonucleic acid flow cytometric and morphologic characterization in 93 cases

OBJECTIVES

To characterize adenocarcinomas of the urinary bladder by their DNA profiles and their proliferative properties.

METHODS

Primary nonurachal adenocarcinomas, found in 93 patients with bilharzial bladder carcinomas, were studied using DNA flow cytometry. Tumor ploidy and S-phase fraction were related to tumor grade, stage, cell type, and lymph node status.

RESULTS

Aneuploidy with high S-phase fractions, found in 90% of the tumors, demonstrates the high malignancy potential of these tumors, the majority of which were found to be muscle-infiltrative. There were no relationships between ploidy or S-phase fraction and tumor grade and stage. Lymph node metastases, present in 24% of the 93 patients, were found exclusively in nontetraploid aneuploid tumors with high S-phase fractions exceeding 100%. Paraffin-embedded tissues compared with fresh material gave the same information on ploidy, whereas bladder washing did not provide adequate information.

CONCLUSIONS

The high aggressiveness of adenocarcinomas in the biharzial bladder is confirmed and can be explained by their proneness to develop gross chromosomal aberrations combined with high cell proliferation.

Prognostic significance of flow-DNA analysis and cell surface isoantigens in carcinoma of bilharzial bladder

Flow cytometric DNA analysis and ABO(H) cell surface antigen expression were studied in 46 patients with cystectomies for carcinoma of bilharzial bladder. The most significant prognostic indicators were the DNA index and the status of the pelvic lymph nodes at operation. Diploid tumors were associated with a low metastatic potential (7.7%) and a better five-year survival (54%) in contrast to aneuploid cases that had a higher metastatic potential (45.5%) and a low five-year survival (21%). The ABO(H) isoantigen status did not correlate with pathologic parameters or the clinical course of these invasive bilharzial bladder tumors as was previously reported.

Clinical application of flow cytometry for DNA analysis of solid tumors

Recent developments of flow cytometry (FCM) technology which make multiple correlative biological measurements on normal and neoplastic cells is affecting areas of diagnostic pathology as well as research fields, and a general understanding of FCM techniques is essential for pathologists. Today, FCM DNA measurements of tumors also becomes routine in the clinical and/or pathological laboratory for aid in cancer diagnosis and cancer treatment. It can also contribute to diagnosis of tumors as a supplemental method to conventional histopathology, and DNA ploidy and the percentage of S-phase fraction are considered as complementary prognostic parameters independent of the stage of disease. This article reviews clinical applications of flow cytometry focusing on the DNA measurements of solid tumors, and related practical issues, such as the methodology for nuclear DNA measurement, interpretation of DNA histograms and the relationship of DNA ploidy and S-phase fraction to clinical and pathological features of human solid tumors.

Prediction of lymph node metastases in bladder carcinoma with deoxyribonucleic acid flow cytometry

The deoxyribonucleic acid patterns in lymph node metastases in relation to the degree of ploidy and proliferation in the primary bladder tumor were evaluated in 162 patients who underwent cystectomy for muscle invasive bladder carcinoma. The 34 diploid tumors had given rise to lymph node metastases in only 2 cases (6%), whereas 34% of the aneuploid tumors had metastasized. The frequency of lymph node metastases increased with the proportions of S-phase cells. In transitional cell carcinoma all tumors with a proportion of S-phase cells exceeding 20% had metastasized, while tumors with a proportion of S-phase cells between 10 and 20%, and less than 10% had metastases in 50 and 33%, respectively. The degree of ploidy of aneuploid tumors seems to be of importance for the potential to give rise to metastases, since the majority of metastatic tumors were in the triploid-tetraploid and hyperdiploid but not hypertetraploid regions. The degree of ploidy of lymph node metastases was in good agreement with that of the primary tumors.