Norming U, Tribukait B, Gustafson H, Nyman C R, Wang N N, Wijkström H
Department of Urology, South Hospital, Stockholm, Sweden.
J Urol. 1992 Jan;147(1):11-5. doi: 10.1016/s0022-5347(17)37120-3.
In 63 patients with primary grade 3 carcinoma in situ of the bladder flow cytometric deoxyribonucleic acid (DNA) analysis was performed at diagnosis and during an average followup of 63 months. The results of DNA measurements were related to disease progression, that is invasive tumor and/or metastatic disease. The DNA histograms were classified as diploid (2 patients) or aneuploid (61). A total of 3 categories of aneuploid tumors with different prognostic significance could be defined: 1) carcinoma in situ with 1 aneuploid cell population at diagnosis and with no change to multiple aneuploid cell populations throughout observation, 2) carcinoma in situ with 1 aneuploid cell population at diagnosis but with a later change to multiple aneuploid cell populations and 3) carcinoma in situ with multiple aneuploid cell populations already at diagnosis. At 5 years the progression-free survival for the 3 categories was 94%, 43% and 20%, respectively. Over-all, of the patients with multiple aneuploid cell populations (categories 2 and 3) 76% had progression, in contrast to 19% of those in category 1 (p less than 0.0005). In category 2 development of multiple aneuploid cell populations preceded progression in 8 of 11 progressive cases by an average of 20 months. Therefore, the occurrence of multiple aneuploid cell populations must be considered as a sign of high aggressiveness. We conclude that flow cytometric DNA analysis is a potent predictor of prognosis in cases of primary carcinoma in situ of the bladder.
对63例原发性膀胱原位3级癌患者在诊断时及平均63个月的随访期间进行了流式细胞术脱氧核糖核酸（DNA）分析。DNA测量结果与疾病进展相关，即浸润性肿瘤和/或转移性疾病。DNA直方图被分类为二倍体（2例患者）或非整倍体（61例）。总共可以定义3类具有不同预后意义的非整倍体肿瘤：1）诊断时为1个非整倍体细胞群的原位癌，在整个观察期间无变化至多个非整倍体细胞群；2）诊断时为1个非整倍体细胞群但后来变为多个非整倍体细胞群的原位癌；3）诊断时已有多个非整倍体细胞群的原位癌。5年时，这3类患者的无进展生存率分别为94%、43%和20%。总体而言，具有多个非整倍体细胞群的患者（2类和3类）中有76%发生了进展，而1类患者中这一比例为19%（p<0.0005）。在2类中，11例进展性病例中有8例在进展前平均20个月出现多个非整倍体细胞群。因此，多个非整倍体细胞群的出现必须被视为高侵袭性的标志。我们得出结论，流式细胞术DNA分析是膀胱原发性原位癌预后的有力预测指标。
