The prognostic significance of S-Phase analysis in stage Ta/T1 bladder cancer. A Southwest Oncology Group study

Ralph W. DeVere White, Arline D. Deitch, Siamak Daneshmand, Brent Blumenstein, Bruce A. Lowe, Arthur I Sagalowsky, Joseph A. Smith, Paul F. Schellhammer, Thomas H. Stanisic, H. Barton Grossman, Edward Messing, John D. Crissman, E. David Crawford

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objectives: An intergroup study (SWOG 8795) comparing two forms of adjunctive therapy (immuno and chemo), bacillus Calmette-Guerin (BCG) and mitomycin C (MMC), furnished preregistration index tumors for 244 patients with superficial, papillary stage Ta/T1 TCC. These were examined by flow cytometry to learn whether DNA ploidy or proliferation (low vs high S-phase fraction (SPF) helped to predict disease recurrence or progression. Methods: Cell cycle analysis using commercially available (Multicycle) programs was performed on 249 Ta/T1 bladder cancers. Tumor grade, available for 223 cases, was assigned by a single study pathologist. The SWOG statistical office reviewed follow-up information and other data and performed statistical analysis. Results: Disease recurrence occurred in half the cases studied. The most parsimonious model predictive of recurrence included only treatment arm and tumor grade, with the MMC arm and tumor grade greater than I indicating worse prognosis (p = 0.014). Neither ploidy nor SPF predicted recurrence-free survival or contributed prognostic information that was additive to tumor grade. Within 5 years of follow-up, disease progression or death from bladder cancer occurred for 29/223 (13%) of patients. The most parsimonious model for progression-free survival included only grade greater than I (p < 0.001) and high SPF (p = 0.029) (relative risk: tumor grade, 4.3, high SPF, 1.9). Conclusions: Knowledge of tumor proliferation (low versus high SPF) contributes prognostic information about tumor progression that is additive to tumor grade. Copyright (C) 2000 S. Karger AG, Basel.

Original languageEnglish (US)
Pages (from-to)595-600
Number of pages6
JournalEuropean urology
Issue number5
StatePublished - 2000


  • Bladder neoplasm
  • Cell cycle
  • Flow cytometry
  • Statistical models

ASJC Scopus subject areas

  • Urology


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