S-phase fraction in superficial urothelial carcinoma of the bladder--a prospective, long-term, follow-up study.
OBJECTIVE
To study, in addition to traditional tumor characteristics at diagnosis, the significance of DNA ploidy and S-phase fraction for tumor progression and tumor-related death in superficial carcinoma of the urinary bladder.


METHODS
Newly detected superficial bladder carcinomas (stage Ta-T1), from 195 consecutive patients were characterized according to stage, grade, tumor size, multiplicity, growth pattern, cytologic evaluation and random mucosal biopsies, as well as DNA ploidy and S-phase fraction as determined by means of DNA flow cytometry. The outcome of disease was evaluated using hospital charts and death certificates.


RESULTS
During a median follow-up period of 98 months (range 1-160 months), 28 patients (14%) progressed to muscle-invasive or metastatic disease and 24 (12%) died from disease. In univariate analysis all factors studied, with the exception of the size and number of tumors at diagnosis, were significantly related to progress and tumor-specific survival. In multivariate analysis, however, S-phase fraction was the most significant prognostic factor. When 21 high-risk patients with T1G3 tumors who underwent early cystectomy were excluded, S-phase fraction remained the most important prognostic factor. DNA ploidy failed as an independent predictor of survival.


CONCLUSIONS
High S-phase fraction at diagnosis of superficial urothelial carcinoma of the bladder identifies patients at high risk of progression and death from disease.
Falkman
Karin
K
Department of Urology, South Hospital, Stockholm, Sweden. karin.falkmam@sos.sll.se
Tribukait
Bernhard
B
Nyman
Claes R
CR
Larsson
Per
P
Norming
Ulf
U
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011003:Ploidies; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D016196:S Phase / Q000502:physiology*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D019459:Urothelium / Q000473:pathology
D014408:Biomarkers, Tumor