Abstract
Genetic instability is the basis for the evolution of tumor cell clones with different genotypic and phenotypic characteristics. Intratumoral heterogeneity concerning DNA ploidy was analyzed in 192 renal cell carcinomas using flow cytometry after propidium iodide staining. DNA ploidy pattern and its influence on clinicopathological parameters was analyzed. Eightyfive tumors (45%) were homogeneously concerning ploidy. Heterogeneous tumors contained in most cases (79%) both diploid and aneuploid cell clones. Patients with homogeneously diploid tumors had a significantly lower incidence of local tumor spread and survived longer than aneuploid tumors (<i>P</i><i><</i>0.001) but the frequency of distant metastases at time of diagnosis was similar. The study demonstrates a frequent heterogeneity in renal cell carcinoma but the heterogeneity itself did not influence survival. The occurrence of aneuploidy in one or several samples of a renal cell carcinoma seemed to be important for the malignant potential, demonstrating that multiple samples must be investigated in order to properly evaluate the malignant character in renal cell carcinoma. Based on our results a model with different pathways for the evolution of renal cell carcinoma is suggested.
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