Badalament R A, O'Toole R V, Kenworthy P, Young D C, Keyhani-Rofagha S, Simon J, Perez J F, Drago J R
Department of Surgery, Ohio State University, Columbus.
J Urol. 1990 Oct;144(4):859-63. doi: 10.1016/s0022-5347(17)39609-x.
A total of 50 patients with primary transitional cell carcinoma of the upper urinary tract underwent deoxyribonucleic acid ploidy characterization by flow cytometric analysis of paraffin embedded specimens. The primary tumor was diploid in 29 patients (58%) and aneuploid in 21 (42%). Aneuploidy was identified more frequently in grade 3 than in grades 1 and 2 neoplasms (p = 0.001). Additionally, grade 3 neoplasms occurred more often with invasive (stages T2 to T3) compared to superficial (stages TA, TIS and T1) tumors (p = 0.002). However, deoxyribonucleic acid ploidy was not significantly associated with tumor stage. Among the 49 patients treated by a definitive operation the median survival free of disease and median over-all survival were 33.7 and more than 120 months, respectively. Variables examined included deoxyribonucleic acid ploidy, tumor grade, tumor stage, primary tumor site and type of operation. In the univariate analysis deoxyribonucleic acid ploidy was the only significant predictor of survival free of disease (p = 0.04). Aneuploid tumors had a median survival free of disease of 19 versus 59 months for diploid tumors. However, in the multivariate analysis of factors affecting survival free of disease, the type of operation performed was the only significant variable. Patients undergoing nephroureterectomy with en bloc bladder cuff excision had a favorable survival free of disease (p = 0.04). Tumor stage was the only significant factor associated with over-all survival in univariate and multivariate analyses (p = 0.02 and 0.005, respectively). Patients with superficial tumors had a median survival of more than 120 versus 72 months for patients with invasive tumors. The data suggest that deoxyribonucleic acid ploidy may be a useful parameter to identify risk groups and plan the management of patients with primary transitional cell carcinoma of the upper urinary tract.
共有50例原发性上尿路移行细胞癌患者，通过对石蜡包埋标本进行流式细胞术分析来进行脱氧核糖核酸倍体特征分析。29例患者（58%）的原发性肿瘤为二倍体，21例（42%）为非整倍体。非整倍体在3级肿瘤中比1级和2级肿瘤中更常见（p = 0.001）。此外，与浅表性（TA、Tis和T1期）肿瘤相比，3级肿瘤更常伴有浸润性（T2至T3期）肿瘤（p = 0.002）。然而，脱氧核糖核酸倍体与肿瘤分期无显著相关性。在49例接受确定性手术治疗的患者中，无病生存期的中位数和总生存期的中位数分别为33.7个月和超过120个月。所检查的变量包括脱氧核糖核酸倍体、肿瘤分级、肿瘤分期、原发性肿瘤部位和手术类型。在单因素分析中，脱氧核糖核酸倍体是无病生存期的唯一显著预测因子（p = 0.04）。非整倍体肿瘤的无病生存期中位数为19个月，而二倍体肿瘤为59个月。然而，在影响无病生存期的多因素分析中，所进行的手术类型是唯一的显著变量。接受肾输尿管切除术并整块切除膀胱袖口的患者无病生存期良好（p = 0.04）。在单因素和多因素分析中，肿瘤分期是与总生存期相关的唯一显著因素（分别为p = 0.02和0.005）。浅表性肿瘤患者的中位生存期超过120个月，而浸润性肿瘤患者为72个月。数据表明，脱氧核糖核酸倍体可能是识别风险组和规划原发性上尿路移行细胞癌患者管理的有用参数。
