The activities of 6
enzymes of carbohydrate metabolism were estimated in superficial
transitional cell carcinomas from 103 patients undergoing transurethral resection of the bladder for the first time. The patients were followed by quarterly endoscopic examinations for a maximum of 81 months (median 33 months). During followup 24 patients had progressive disease. The activities of
phosphofructokinase and
phosphohexose isomerase were significantly lower in
tumors from patients whose disease had superficially invaded the lamina propria (stage pT1) than in others in whom it was confined to the bladder mucosa (stage pTa). Similarly the activities of the 2
enzymes were significantly higher in well differentiated (grade 1) than in moderately well differentiated (grade 2)
carcinomas. Univariate analyses using the log rank test showed that neither pathological stage nor
malignancy grade of the
carcinoma was a significant factor in predicting the risk of progression. Of the 6
enzymes, below median activities of
phosphofructokinase,
lactate dehydrogenase and
phosphohexose isomerase were associated with a significantly increased risk of progression in these patients. Multivariate analyses using Cox's proportional hazards model showed that the activity of lactic
dehydrogenase in superficial
transitional cell carcinoma is an independent prognostic factor in predicting the risk of progression. It is postulated that the measurements of the activities of the 3
enzymes in
tumors from patients with superficial
transitional cell carcinoma might help to select individual patients with a high risk of progression for adjuvant intravesical treatments.