The biologic potential of a tumor for growth and metastasis is relatively inaccurately mirrored by the present staging system in colon cancers [29]. Except for Stage IV disease, traditional morphologic criteria approaches only 50-75% accuracy for predicting recurrent disease. Reliable staging, however, has become more critical in the light of the current thrust in adjuvant therapy research. First, the patients receive toxic and expensive therapy. Second, and of even greater importance, a central tenet of adjuvant therapy research is that treatment and control groups under study are comparable. Inadequate staging not only undermines analysis, especially when small improvements of lo-20% may be expected, but also demands very large study groups to offset this defect. A significant amount of research has attempted to quantitate the metastatic potential of a tumor. In the animal model some factors such as cell adhesiveness, tumor angiogenesis, detachability, thromboplasticity, and shedding of membrane antigen have been associated with an increased propensity of a tumor to spread [23]. In the clinical forum, analysis of factors such as tumor grade [4, 71, vascular invasion [7], host immune status [ 1, 8, 91 have not been established as having a clear-cut prognostic value. Hopefully prospective studies, objective criteria, and more sophisticated statistical analysis [6] may yield less disappointing results in the future. In this respect, accumulating evidence indicates that the analysis of tumor kinetics will be a major determinant of the metastatic potential of a tumor. It is well established that kinetic data of tumor doubling time and labeling index (LI) is associated with length of survival [ 11, 18, 21, 271, but the effect of tumor doubling time on ultimate survival was reported by Joseph et al. [12, 161. In his report, patients with resection of solitary pulmonary metastasis with doubling times less than 40 days subsequently died of metastasis whereas 60% of the patients with tumor doubling time over 40 days were cured. Other measures of tumor proliferative activity, i.e, mitotic index in sarcomas 1281 and labeling index in breast cancer patients 1151 have recently been implicated as important prognostic determinants, and in the former instance has been incorporated into the A.J.C. stating system [20] as a factor influencing tumor grading. Finally, the development of flow cytometry [24] has now made the rapid and objective analysis of cell cycle kinetics an exciting clinical reality. In this study, the predictive potential of cell cycle analysis by flow cytometry was examined by comparing the proliferative activity of colorectal adenocarcinoma with Duke’s staging and modified Broder’s grading.
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