The relation between the results of cytophotometric examination of endometrial carcinoma and clinical course of these disease

Low-risk endometrial carcinoma: assessment of a treatment policy based on tumor ploidy and identification of additional prognostic indicators

OBJECTIVES

The aims of this study were (1) to assess a treatment policy for patients with low-risk endometrioid endometrial carcinoma where adjuvant treatment decisions have been based on ploidy status of the tumor, and (2) to screen diploid, low-risk tumors for additional features of prognostic significance.

METHODS

Between 01/1992 and 08/1996, 406 patients were referred to the B.C. Cancer Agency-Vancouver Clinic with typical endometrial adenocarcinomas limited to <50% myometrial invasion and no vascular space invasion or grade 3 disease on pathology review ("low-risk stage I endometrial carcinoma"). Patients were prospectively assigned to treatment groups based on tumor ploidy. Those patients with aneuploid tumors (n = 91) were treated with adjuvant vaginal vault radiotherapy while those with diploid tumors (n = 315) were followed and treated only at relapse. The hysterectomy specimens from all 14 patients in the untreated, diploid group who relapsed, as well as 28 stage- and grade-matched diploid controls who did not fail, were analyzed by immunohistochemical staining for estrogen receptor (ER), Bcl-2, and p53 proteins.

RESULTS

There were no significant differences in the stage (Ia vs Ib) and grade (G1 vs G2) distribution for the diploid and aneuploid groups. Overall median age was 64 years (range 27-90 years) and was also not significantly different for the two groups. The median follow-up for the entire cohort is 45 months (range 1-76 months). There have been 14 failures in the diploid group and 4 failures in the aneuploid group with actuarial 5-year disease-free survival rates of 95.0 and 95.2%, respectively (P = NS). Eight of the failures in the diploid group occurred at the vaginal vault and were all subsequently salvaged with radiotherapy. All but 1 of the failures in the aneuploid group were considered incurable. Of the 14 diploid tumors from patients who failed, 7 stained positively for p53, compared to 4 of 28 diploid controls (P = 0.02). No significant differences were seen in the diploid tumors that recurred, compared to controls, with respect to Bcl-2 or ER expression.

CONCLUSIONS

Patients with diploid, low-risk stage I endometrial cancers have excellent prospects for relapse-free and overall survival. Patients with aneuploid tumors treated with adjuvant radiotherapy have the same risk of relapse as untreated patients with diploid tumors; however, their ultimate survival may be lower as a smaller proportion of aneuploid failures are salvageable. While p53 expression in diploid tumors is associated with increased risk of relapse, Bcl-2 and ER are not useful prognostic indicators in this setting.

Relations between various DNA-parameters and degree of malignancy in endometrial carcinoma

120 imprint-cytology specimens obtained from standardized areas of 20 endometrial carcinomas were investigated by use of a computed-controlled image analysis system to determine special quantitative DNA-parameters. The stem line ploidy, the 2c deviation index (2cDI), the DNA-associated graduation of malignancy (DNA-MG) as well as the 5c exceeding rate (5cER) were calculated for each preparation. 85% of the imprint-cytology preparations had diploid stem lines, and aneuploidy was found in 15%. There were statistically significant correlations between the DNA-MG, the 5cER and the stem line ploidy as well as between the DNA-MG and the 5cER. The sensitivity of the 5cER was 76.6% in our study and so we cannot regard this parameter as prouding accurate information about tumor malignancy in endometrial carcinoma. Special DNA-parameters defined mathematically should be utilized for objective grading of tumor malignancy.

Cartilaginous tumors: prognostic applications of cytophotometric DNA analysis

BACKGROUND

Traditionally, selection of cancer therapy is based on the assessment of the prognosis of the individual patient. The specific type of tumor and the stage of disease have been the most reliable indicators of prognosis.

METHODS

Image cytometry to determine DNA content was used in conjunction with clinicopathologic parameters and patient survival to investigate 16 cartilaginous tumors. Histopathologic characteristics, cytometric DNA ploidy status, 2c deviation index (2cDI), DNA malignancy grade (DNA-MG), and 5c-exceeding event (5cEE) were used to learn more about the determination of tumor prognosis. Prognosis was analyzed with a maximum follow-up of 148 months.

RESULTS

DNA ploidy status, 2cDI, DNA-MG, and 5cEE are indicators of prognosis. After 148 months of follow-up, patients with aneuploid tumors had a significantly lower overall survival rate compared with those with diploid tumors (P < 0.05). Patients with DNA-MG less than 0.8 or 2cDI less than 1.5 had a significantly longer overall survival rate with respect to the group of patients with a DNA-MG greater than 0.8 or 2cDI greater than 1.5 (P < 0.001). A significant difference was noted in the overall survival rates between patients with tumors with 5cEE less than 3 and 5cEE 3 or greater (P < 0.001).

CONCLUSION

Image cytophotometry DNA ploidy status, 2c deviations index, DNA malignancy grade, and 5c exceeding event were investigated and were found to be of prognostic value for patients with cartilaginous tumors.