S‐phase fraction in superficial urothelial carcinoma of the bladder
A prospective, long‐term, follow‐up study

Abstract

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.

Material and 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.

• bladder neoplasms
• cell proliferation
• flow cytometry
• survival