Prognostic Relevance of DNA Ploidy and Proliferative Activity in Urothelial Carcinoma of the Renal Pelvis and Ureter

Abstract

In 55 patients with urothelial carcinoma of the renal pelvis or ureter, the ploidy, the DNA heterogeneity and the counts of cell cycle phases in the tumor were examined by means of single-cell DNA cytophotometry in order to find more prognostic factors than those already known (stage and grade). Follow-up periods ranged from 1 to 6 years. At the time of first diagnosis, 42 (76%) of the patients had tumors of the renal pelvis, 13 (24%) of them had ureteral tumors. 23 (42%) patients were in stage pT 1 N 0, 15 (27%) in stage pT 2 N 0, 12 (22%) in stage pT 3 N 0, and 5 (9%) were in stage pT 3 N +. The histological malignancy grade most frequently seen in the patients examined – i.e. in 51% of cases – was malignancy grade II. 25% of the patients had grade III tumors whereas only 24% had grade I tumors. With malignancy grade I, DNA cytophotometry showed DNA frequency peaks to be in the diploid range while tumors with malignancy grade II showed heterogenous DNA patterns. 71% of the patients with malignancy grade III showed aneuploid DNA values; 29% of them had polyploid DNA values. For malignancy grades II and III, the proliferation rate of the tumor cells was statistically significantly higher than for malignancy grade I. The determination of tumor heterogeneity and tumor cell proliferation by means of DNA cytophotometry gives valuable clues regarding prognosis.

Nucleolar and argyrophilic nucleolar organizer region counts in urothelial carcinomas with special emphasis on grade II tumors

“…Numerous DNA analyses showed that grade I transitional cell carcinomas are predominantly diploid and grade III carcinomas are almost exclusively aneuploid. Approximately 30%-40% of grade II carcinomas are diploid and 60%-70% are aneuploid or polyploid [3,16]. The heterogeneous nature of the grade II group was also demonstrated with respect to nuclear size and DNA pattern [7,24].…”

“…However, the prognosis of carcinomas with limited invasion and intermediate differentiation showing mixed papillary/solid growth pattern is difficult to predict. Various methods assessing cell proliferation such as thymidine autoradiography, DNA-cytometry and immunohistochemical proliferation assays have been used to subgrade this group of bladder tumours [1,2,3,12,26]. The results of these studies were promising, but there is still a need for simple measures to predict the prognosis of the intermediate group of bladder carcinomas.…”