DNA index and S-phase fraction in curative resection of colorectal adenocarcinoma: analysis of prognosis and current trends.

The DNA index (DI) and S-phase fraction (SPF) have been said to be independent factors in colorectal adenocarcinoma and have a different distribution from the clinicohistologic parameters. This study assesses the real efficacy of DI and SPF for curative resection of colorectal adenocarcinomas with respect to the prognosis and the clinicohistologic parameters. From July 1991 to October 1994 a total of 666 patients underwent curative resection of colorectal adenocarcinoma and DNA flow cytometry in Kaohsiung Chang Gung Memorial Medical Center Hospital, Taiwan. We defined diploid tumors as having a DI of ? 0.9 but <1.1 and a nondiploid tumor as having a DI of <0.9 OR > 1.1. A high SPF was defined as being more than the median value for the total SPF. Altogether, 495 cases (74.32%) had a 5-year cancer-free survival. Tumor stage, DI, tumor location, and tumor morphology were associated with significant cancer-free survival in the univariate analysis (p = 0.0295, <0.001, 0.0357, and <0.001, respectively). After all factors were entered into the multivariate analysis, the independent factors for cancer-free survival were found to be stage, tumor location, and morphology (p < 0.001, 0.012, and 0.044, respectively). In cases distinguished by the DI, diploid tumors had significantly more frequent right colon locations (p <0.001). After cases were separated by the SPF (median value 18.4%), better histology (well differentiated adenocarcinoma) was noted with a low SPF (p = 0.017). No other clinicohistologic parameters had significant differences shown by the DI or SPF. Thus DI and SPF failed to appear as independent factors for 5-year cancer-free survival. The independent factors for curative colorectal adenocarcinoma were tumor stage, location, and morphology. Diploid tumors were located at the right colon more often, and low SPF indicated better histology in the univariate analysis.