Transitional cell carcinoma of the bladder : histopathological and biological factors and prognosis

The main purpose of the studies reported in this thesis has been to determine the extent to which the behaviour of TCC can be predicted by histopathological and biological characteristics. The potential additional prognostic value of these factors was evaluated by combining them with other prognostic factors in multivariate analysis. In chapter 2 a two grade system of histological grading .. using simple histological criteria, is proposed. The interobserver variability of the WHO grading system and the two grade system is tested. The extent to which patient survival and progression free survival correlated with the two grade system, is evaluated. The additional value of grading is tested by combining it with other prognostic factors such as stage, age and mitotic index in multivariate analysis. In chapter 3 BM expression in TCC is described in an attempt to evaluate its use for the histopathological identification of microinvasion. Furthermore the usefulness of BM staining for the prediction of the clinical behaviour of TCC is assessed in comparison with grading, staging and ploidy. In chapter 4 the use of a two grade morphometrical grading system for prediction of the clinical behaviour of TCC is described. Also the heterogeneity in the WHO grade II tumours is evaluated using morphometry. In chapter 5 a study is reported in which it is determined whether image cytometry can provide useful parameters which can be used in the prediction of TCC behaviour. Special attention is given to the potential value of rare incidents, e.g. occasional cells with a very high DNA content. In chapter 6 a study is described concerning numerical chromosome aberrations in TCC as assessed by counting chromosomes in metaphase spreads. The modal number of chromosomes and the chromosomal range are used as potential prognostic factors in comparison with histological parameters. In chapter 7 "classical" metaphase chromosome counting is compared with interphase cytogenetics, especially in tumours having diploid and hyperdiploid DNA content. In chapter 8 The findings of these studies are discussed and general conclusions are drawn

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