Chromosomal analysis of bladder cancer. II. A practical method

Cytogenetic analysis in transitional cell carcinoma of the bladder

The potential use of numerical chromosomal abnormalities as predictive factors for the clinical behaviour of transitional cell carcinoma (TCC) was investigated. The effects on survival and progression-free survival were measured in 91 patients with TCC treated by transurethral resection. The survival rate of patients having tumours with a diploid chromosomal modal number was significantly better than that of patients having tumours with a hyperdiploid chromosomal modal number. The survival rate of patients having TCC with diploid cells only was also significantly better than that of patients having TCC with both diploid and hyperdiploid cells. Progression-free survival was significantly higher in patients having TCC with a diploid modal number of chromosomes than in patients with a hyperdiploid modal number. Simultaneous evaluation of the modal chromosome number or chromosomal range, histological grade, category and mitotic index of the tumour, and the patient's age and sex as prognostic factors in multivariate analyses showed that the category of bladder carcinomas was the most important factor in predicting the survival rate. In patients with superficial tumours (category Ta and T1) the modal chromosome number was the most important factor in predicting survival. For progression-free survival, the modal chromosome number appeared to be the most important factor. It was concluded that the modal chromosome number in TCC was useful in predicting survival in patients with superficial tumours and in predicting progression-free survival in patients with tumours of all categories.

Heterogeneity in bladder cancer as detected by conventional chromosome analysis and interphase cytogenetics

Thirty transitional cell carcinomas (TCCs) of the bladder were examined by classical chromosome counting to establish range, modal number, and percentage of metaphases with 2n, 3n, 4n, and > or = 5n chromosomes. In addition, fluorescence in situ hybridization (FISH) was applied to interphase nuclei to detect the percentage of tumor cells showing polyploidization and chromosome imbalance. In FISH, centromere-specific DNA probes for chromosomes 1, 7, 9, and 11 were used. The tumors were analyzed flow cytometrically to determine the DNA index (DI). Fourteen of 21 cases (67%) having a DI = 1 showed, after classical chromosome counting, in addition to a diploid model number, some cells with a 3n and 4n chromosome count. With FISH, eight cases (38%) showed a low percentage of cells with multiple signals for each of the probes, thus indicating polyploidization. In 13 (62%) cases, an imbalance between different chromosomes was detected. In nine tumors having a DI of 1.6 to 1.9, classical chromosome counting showed low percentages of > or = 5n cells in four cases, in addition to a triploid modal number. With FISH in six cases, a low percentage of cells showed five or more signals for each of the chromosomes, indicating polyploidization. In all cases, a chromosome imbalance was detected. With classical chromosome counting not all tumors can be analyzed. With FISH, small percentages of polyploid cells are not recognized. Both methods complement each other in that chromosome counting allows readier detection of heterogeneity in DNA-diploid tumors after polyploidization, whereas FISH allows efficient recognition of the chromosomes involved in the process of imbalance.

Image cytometric DNA analysis in transitional cell carcinoma of the bladder

BACKGROUND

The current study was initiated to investigate measurable objective and reproducible characteristics that might have prognostic significance in bladder cancer.

METHODS

Tumor samples from 91 patients with primary transitional cell carcinoma (TCC) of the urinary bladder were studied by DNA image cytometry and cytogenetic analysis. Image cytometry is a more sensitive method of determining ploidy than flow cytometry, especially in tumors with a low number of aneuploid cells.

RESULTS

There was a significant difference in survival between DNA image cytometry-determined diploid and nondiploid cases. The presence of nuclei with a high DNA content indicated poor prognosis. The 2C deviation index (2CDI) also was an indicator of survival. Image cytometry-determined factors also were found to be strong predictors of progression-free survival. In multivariate analysis, 2CDI was the only cytometric parameter with an independent but weak correlation with survival. In multivariate analysis, none of the cytometric parameters had an important contribution to prediction of progression-free survival. In superficial tumors (Ta and T1), 2CDI appeared to be the most important independent predictor of survival. With respect to progression-free survival, tumors with a high mitotic index proved to have a worse prognosis.

CONCLUSIONS

Parameters determined by DNA image cytometry appear to be valuable in predicting survival and progression-free survival and may be useful in addition to the classic parameters of stage and grade, especially in superficial TCC.

Chromosome 9 anomalies as the primary clonal alteration in a case of squamous cell carcinoma of the epiglottis

We present the cytogenetic characterization of a short-term culture of a primary squamous cell carcinoma of the epiglottis from a 67-year-old male patient who was admitted to this hospital for treatment. This patient had a history of chronic exposure to tobacco and alcohol, environmental carcinogens known to be related to the etiology of the disease. The tumor karyotype showed three distinct clones: 1) cells with chromosome 9 anomalies; 2) cells with chromosome 9 and other clonal structural anomalies involving chromosomes 1, 11, 14, and 17; and 3) cells whose chromosomes were partially or totally pulverized. The anomalies on chromosome 9 were homozygous inversion (p12q13), deletions at regions q22, q34.1, and p13, and i(9q) formation. Structural clonal anomalies on other chromosomes included translocations, deletions, and isochromosome formation. The presence of a chromosome 9 anomaly alone or in conjunction with other anomalies suggests that this aberration may be a nonrandom primary event in the progression of squamous cell carcinoma of the head and neck.

Cytogenetic studies of five primary esophageal cancers

In direct preparation of five primary esophageal cancers, chromosomes 1, 3, and 12 were most frequently involved in structural abnormalities; 12p- was consistently seen in all five cases and, thus, could be considered as one of the characteristic chromosome changes in esophageal cancer. Moreover, 2p-, 4p-, and 7q- were seen in three cases.

Prognostic significance of type IV collagen and laminin immunoreactivity in urothelial carcinomas of the bladder

Invasion of a carcinoma involves the degradation and penetration of the subepithelial basement membrane (BM). This phenomenon might be used for histopathologic evaluation of neoplasms of the bladder. The authors studied the clinicopathologic data and tissue specimens of 125 cases of urothelial carcinomas collected prospectively. Penetration of the BM was evaluated by immunohistochemical staining of the BM components laminin and type IV collagen. The use of this parameter as a prognostic indicator in bladder cancer was assessed. The 5-year survival rate of patients having tumors with an interrupted or absent BM was significantly lower than that of patients having tumors with an intact BM. The rate of progression was greater in tumors with an interrupted or absent BM than in tumors with an intact BM. No association was found between BM status and recurrence. However, a significant correlation between tumor stage and BM staining was found. A correlation was also found between ploidy and BM staining as well as between histologic grade and BM staining pattern. When evaluating histologic grade, stage, ploidy, age, and BM score as prognostic parameters, the stage of bladder carcinomas turned out to be the most important factor in predicting the survival rate and the progression-free survival. However, BM staining was found to be of value for early identification of microinvasion and is helpful for correct staging of urothelial carcinomas.

Chromosomal analysis of bladder cancer. III. Nonrandom alterations

Chromosome analysis using G- and C-banding was performed on 13 primary transitional cell carcinomas of the bladder. The chromosome preparations were obtained by a direct method. In eight tumors with a (near) diploid modal chromosome number, the most frequently observed chromosome aberrations were: (partial) monosomy 9 in four cases, deletion of 10q in two cases, and partial trisomy 1 in two cases. In five tumors with a modal chromosome number in the triploid or tetraploid range the chromosomes #1, #3, #7, #9, #11, and #17 were numerically and or structurally abnormal in at least four cases. In three out of ten males, the Y chromosome was missing. These findings suggest that the loss of chromosome #9, and possibly also loss of 10q is a primary event in the karyotypic evolution of transitional cell carcinoma of the bladder.