Deoxyribonucleic Acid Ploidy and the Clinical Pattern of Grade 2 Superficial Bladder Cancer

Abstract

We attempted to find an objective and quantitative parameter that would enable us to differentiate between aggressive and nonaggressive grade 2 superficial transitional cell carcinoma of the bladder. This type of tumor belongs to a heterogeneous group, 30% of which behave aggressively by invading lamina propria and muscle tissue in the course of the evolution. The remaining 70% of tumors have less aggressive qualities, are nonprogressive and have a low recurrence rate. To date to our knowledge there is no way to differentiate between these 2 subpopulations of tumors. We performed a retrospective flow cytometric analysis of deoxyribonucleic acid (DNA) ploidy and cell cycle phases on primary and solitary formalin fixed and paraffin embedded tumor tissue. Of the 41 specimens studied 16 were aneuploid and 25 were diploid. Aneuploidy was associated with progressive disease and high mortality rates, particularly in patients who did not receive postoperative adjuvant intravesical instillation. DNA diploidy was equated with lack of mortality and a low progression rate. The use of intravesical bacillus Calmette-Guerin as an adjuvant postoperative treatment was associated with low recurrence rates. In this group elevated G2M percent and S phase fractions correlated with higher recurrence rates. DNA ploidy was a prognostic factor in stage Ta grade 2 bladder transitional cell carcinoma and should be considered as a complementary test to histopathological analysis. Adjuvant instillation with bacillus Calmette-Guerin is advised after transurethral resection of primary solitary aneuploid stage Ta grade 2 bladder transitional cell carcinomas and of primary solitary diploid tumors with elevated G2M percent and S phase fraction.