Stereologically measured nuclear volume in comparison to two-dimensional nuclear morphometry, mitotic index and flow cytometry in predicting disease outcome in bladder cancer.

The prognostic value of stereologically estimated nuclear volume was compared to the prognostic value of clinical, histological, morphometric and flow cytometric prognostic factors in a cohort of 212 patients followed up for over 11 years. T-category (p = 0.014), grade (p < 0.0001), papillary status (p = 0.001), nuclear area (p < 0.0001), SD of nuclear area (p < 0.0001), DNA ploidy (p < 0.0001), S phase fraction (p < 0.0001), mitotic index (p < 0.0001) and nuclear volume were significantly interrelated. Progression in T- (p = 0.090), N- (p = 0.007) and M-categories (p = 0.001) was related to nuclear volume, while independent predictors of progression in a multivariate analysis were grade and S phase fraction. Nuclear volume predicted survival in the entire cohort (p = 0.0004) and in papillary tumours (p = 0.0048), whereas in superficial tumours it had no prognostic value. In multivariate survival analysis T-category (p < 0.001), papillary status (p < 0.001) and S phase fraction (p = 0.011) predicted survival and S phase fraction predicted (p = 0.052) recurrence-free survival in Ta-T1 tumours. The results suggest that stereological measurement of nuclear volume provides no additional prognostic information over proliferation indices (mitotic index, S phase fraction) in bladder cancer.