Cytomorphometric and flow cytometric analysis of bladder transitional cell carcinoma using acridine orange fluorochrome: correlation with histopathology and clinical behavior.

Cell material from 79 cases of archival paraffin-embedded tumor specimens of newly diagnosed transitional cell carcinomas of the urinary bladder was studied retrospectively using rapid flow cytofluorometric DNA analysis. The male to female ratio was 62/17. The mean age at diagnosis was 65.3 +/- 10.8 years. Clinical characteristics, including survival, recurrence and progression were closely related to the histopathologic grading and tumor staging. The tumors were classified as diploid (DI = 0.9-1.1) or aneuploid. Total aneuploid occurrence was 46%. The aneuploid frequency for the various tumor grades was 25% for grade 1, 37% for grade 2 and 78% for grade 3. Stages Ta (O) and Tl (A) tumors differed from muscle-invasive tumors (T2-4) in that they had a lower frequency of aneuploid occurrence (34%, 41% vs 50%, 73%, and 75%). Multiple aneuploid stem cell lines had no influence on tumor grade or stage. The DNA ploidy was closely related to the five-year survival rate, the probability of tumor recurrence and progression. On the contrary, the modal nuclear size of the tumor cells had no correlation with histopathology or the clinical characteristics. Bladder tumors of an intermediate grade (grade 2) may be subdivided into two groups with different outcomes on the basis of flow cytometric characteristics. It is concluded that DNA flow cytometry can serve as an additional prognostic parameter for bladder cancer patients in addition to conventional histopathology.