Flow cytometric nuclear DNA content analysis of renal tumors in children: prognostic significance of nuclear DNA ploidy.

We studied, by flow cytometry, the DNA contents of paraffin-embedded tumor specimens from 90 infants and children with kidney tumors, and analyzed the relationship of DNA ploidy with histological types and prognosis. Data of adequate quality were obtained from 90 cases: 65 tumors with favorable histology, 5 congenital mesoblastic nephromas and 20 tumors with unfavorable histology. The 90 cases had nuclear DNA histogram patterns that were classified as DNA diploid in 64 tumors, aneuploid in 19 and tetraploid in 7. There were no significant correlations between DNA ploidy and histological types or clinical stages. Survival rates for patients with diploidy were 80 and 70% at 2 and 5 years, respectively, and those of patients with aneuploidy were 72 and 61% at 2 and 5 years, respectively. On the other hand, patients with a DNA tetraploid pattern had significantly worse survival rates of 43 and 29% at 2 and 5 years, respectively. Among patients with aneuploidy or tetraploidy, the S-phase fractions in those who died (mean +/- SD: 10.3 +/- 4.1 and 22.1 +/- 11.6%, respectively) appear to be greater than those in their surviving counterparts (8.8 +/- 4.0 and 12.1 +/- 2.8%). Hence, although the differences between diploid and aneuploid DNA patterns were not correlated with differential prognosis in children with kidney tumors, a tetraploid pattern clearly indicates a poor prognosis, especially in combination with histological types and clinical stages.