DNA flow cytometry in gastric carcinoma: Implication in patients with potentially curative resection

Abstract

Background and Objectives The relevance of DNA ploidy as a prognostic factor in patients with gastric cancer is controversial. The prognostic significance of DNA ploidy and its relationship to conventional histological grading and staging of the tumor (TNM stage, Lauren, Ming and WHO classification) were evaluated. Methods DNA ploidy of the tumor was determined by flow cytometry on archival material from 76 patients who underwent R0, D2 stomach resection. Results DNA aneuploidy was found in 39 cases (51%). No significant association between DNA aneuploidy and either patients' sex, pT, pN, type according to Ming or Borrmann and tumor localization was found. The incidence of DNA aneuploidy was significantly lower in tumors of diffuse type according to Lauren, in signet‐ring cell or undifferentiated type (WHO), in grade 3/4 tumors, and in patients younger than 50 years. We found no significant difference in survival of patients with DNA aneuploid when compared to DNA diploid tumors, although the prognosis of the patients with lower DNA index (DI < 1.2) tended to be better than that of higher DNA index (DI > 1.2). Conclusions DNA ploidy appears to be of limited prognostic value after R0, D2 resection of stomach cancer. J. Surg. Oncol. 1997;65:237–241. © 1997 Wiley‐Liss, Inc.

Is there a case for routine clinical application of ploidy measurements in gastrointestinal tumours?

“…The relationship between histological tumour type according to the Laurén classification and ploidy is still controversial. Whereas several reports showed that intestinal‐type gastric cancers are more often DNA aneuploid than diffuse type, 103,118,120,123,129–131,136 other authors found no significant difference between these two tumour types regarding ploidy 101,105,108,117,121,134 . Furthermore, it was found that well‐differentiated carcinomas are more often DNA aneuploid compared with poorly or undifferentiated adenocarcinoma, 100,105,116,125,129,131–133,135,137,138 a correlation that was not confirmed by others 101,103,107,108,113,121,122,134 …”

“…In addition, DNA aneuploidy was established as an independent prognostic marker in several studies 109–124 . Other studies failed to show such a correlation between ploidy and patient survival at all 125–132 …”

“…A number of studies demonstrated that DNA aneuploidy is correlated with advanced local tumour extent (pT) 107,119,120,122–124,133 or increased number of lymph node metastases (pN) 102,103,108,109,115,118,120–124,128,131,133,134 . However, other studies failed to prove this association of DNA aneuploidy and tumour progression 101,105,113,117,125,129,130,135 …”

DNA mapping of gastric cancers using flow cytometric analysis

“…Although this finding may be in conflict with findings in mucosal lesions of submucosal cancers, the data suggest that when cancer cells invade into the submucosa, the mucosal cancer cells (mucosal lesion) in the submucosal cancers acquire a higher DI. Such tumor cells may acquire great proliferative activity in relation to the high DI (18, 19). We believe that this increase in the DI plays an important role in the progression of intestinal‐type gastric cancers.…”