title: DNA image cytometry is a useful adjunct tool in the prediction of disease outcome in patients with stage II and stage III colorectal cancer.
abstract: BACKGROUND
  We assessed the prognostic value of the nuclear DNA content measured in the primary tumours of 123 patients with stage II or stage III colorectal cancer (CRC).
  
  
  METHODS
  Isolated nuclei from paraffin sections were stained with the Feulgen reaction, and DNA was measured using a computer-assisted image analysis cytometry system. We applied 4 different approaches in the analysis of DNA histograms: the ABCDE approach, histogram range, peak evaluation and DNA cut-off values.
  
  
  RESULTS
  Using the histogram range, the narrow range was rare (3.7%) in patients who died of disease (n = 28) as compared with 16.4% among those alive (n = 74; p = 0.017). Modal peak evaluation was a significant predictor of disease-free survival (DFS; Kaplan-Meier log-rank p = 0.0235). In the range evaluation, the 1st set (low-start gates) was a significant predictor of DFS (log-rank p = 0.0121), where disease recurrence was closely associated with the widest range (1.8->10c; c = haploid DNA content) gates. Recurrence-free survival was 3 times better in narrow-gate histograms than wide-range histograms (p < 0.03). The 1st set also proved to be a significant predictor of disease-specific survival (DSS; log-rank p = 0.0045), which was markedly better (77.8-90.0%) among the patients with the narrow-gate histograms. Grading of the histogram range into 2 categories (with 6.0c as cut-off), was a powerful predictor of both DSS (log-rank p = 0.0092) and 5-year DFS (p = 0.0106) in the whole series, and separately in stage III (but not stage II) disease, with p = 0.0131 and p = 0.0201, respectively.
  
  
  CONCLUSIONS
  The DNA image cytometry with careful analysis of the histograms may provide valuable prognostic information in CRC, with potential clinical implications in patient management, particularly in predicting the patients at high risk for recurrence who should be considered as candidates for adjuvant therapy.
authors.affiliation: Department of Oncology and Radiotherapy, Turku University Hospital, University of Turku, Turku, Finland. abuhme@utu.fi
authors.forename: A
authors.initials: A
authors.lastname: Buhmeida
authors.forename: A
authors.initials: A
authors.lastname: Algars
authors.forename: R
authors.initials: R
authors.lastname: Ristamäki
authors.forename: Y
authors.initials: Y
authors.lastname: Collan
authors.forename: K
authors.initials: K
authors.lastname: Syrjänen
authors.forename: S
authors.initials: S
authors.lastname: Pyrhönen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000235:genetics* / Q000473:pathology*; D004273:DNA, Neoplasm; D018572:Disease-Free Survival; D005260:Female; D006238:Haploidy; D006801:Humans; D019044:Image Cytometry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests
chemical_list: D004273:DNA, Neoplasm