Clinical evaluation of cell deoxyribonucleic acid content measured by flow cytometry in bladder cancer

Purpose: We evaluated the clinical value of flow cytometry in bladder cancer. Materials and Methods: Deoxyribonucleic acid (DNA) content was measured by flow cytometry in 275 untreated patients with bladder tumor followed for 1 to 8 years. Four pathological parameters (stage, grade, observed vascular invasion and associated carcinoma in situ) and 3 flow cytometric parameters (ploidy, number of aneuploid cell lines and DNA index) were defined. Results: Univariate survival analysis showed that every parameter, when considered separately, was a significant prognostic factor (p < 0.0001 in all cases). Multivariate analysis showed that stage (p < 0.0001), DNA index (p < 0.01) and associated carcinoma in situ (p < 0.05) were independent, significant prognostic factors. However, ploidy and DNA index enhanced prognostic information above the traditional stage and grade only in patients with a stage pT1, grade 3 tumor (p < 0.05). Retrospectively, different therapeutic decisions could have been made using DNA content only in 4% of cases. Conclusions: In patients with bladder cancer DNA content is an independent predictor of survival but its clinical usefulness is limited.