DNA Ploidy and S-phase Fraction as Predictive Factors of Response and Outcome Following Neoadjuvant Methotrexate, Vinblastine, Epirubicin and Cisplatin (M-VEC) Chemotherapy for Invasive Bladder Cancer

Objective : To investigate the value of DNA ploidy and S-phase fraction (SPF) as factors that could predict response and outcome of invasive transitional cell carcinoma (TCC) of the bladder to neoadjuvant methotrexate, vinblastine, epirubicin and cisplatin (MVEC) chemotherapy. Materials and Methods : Twenty-four patients with localized invasive TCC of the bladder (stages T3 to T4a, NoMo) were treated with neoadjuvant MVEC chemotherapy. DNA flow cytometry was performed in paraffin-embedded tissue obtained by transurethral resection before chemotherapy. Radical cystectomy specimens were utilized for complete pathologic staging. The tumors were subdivided into high- and low-SPF tumors according to their SPF value. DNA ploidy status was evaluated into two groups (diploidy and nondiploidy). Results : DNA ploidy was not correlated to the response to chemotherapy ( p = 0.67), and overall or disease-free survival ( p = 0.27 and p = 0.69, respectively). Major response (pathologic complete response and partial response) was more often found in the high SPF group than among tumors with low SPF ( p = 0.02). High SPF tumors were significantly associated with increased overall and disease-free survival ( p = 0.0056 and p = 0.0059, respectively). Conclusion : A high SPF, but not DNA ploidy, may be helpful to identify patient likely to respond and survive longer following neoadjuvant MVEC chemotherapy in the treatment of invasive bladder cancer.