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Affiliation(s)
- H Fox
- University of Manchester, Manchester, UK
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Kimmig R, Wimberger P, Hillemanns P, Kapsner T, Caspari C, Hepp H. Multivariate analysis of the prognostic significance of DNA-ploidy and S-phase fraction in ovarian cancer determined by flow cytometry following detection of cytokeratin-labeled tumor cells. Gynecol Oncol 2002; 84:21-31. [PMID: 11748971 DOI: 10.1006/gyno.2001.6440] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The outcome of patients with advanced ovarian cancer is poor despite aggressive therapy including surgery and multiagent chemotherapy. Valid prognostic factors are necessary to estimate the course of the disease and to define biologically similar subgroups for analysis of therapeutic efficacy. METHODS This study is the first published prospective study concerning the prognostic significance of DNA-ploidy and S-phase fraction in ovarian cancer following enrichment of tumor cells by cytokeratin labeling. Epithelial cells were labeled by FITC-conjugated cytokeratin antibody (CK 5, 6, 8, and 17) prior to flow cytometric cell cycle analysis in 129 fresh specimens of primary ovarian cancer. RESULTS Recurrence-free survival of patients with DNA-diploid primary ovarian cancer was significantly better compared to that of patients with DNA-aneuploid tumors in univariate analysis (47% vs 18%, P = 0.01). The tumor-dependent overall survival of patients with DNA-diploid tumors was 57% compared to 30% with DNA-aneuploid tumors (P = 0.04). In FIGO stage III ovarian cancer DNA-ploidy, optimized by cytokeratin gating for tumor cells, achieved independent prognostic significance. No significance was found for S-phase fraction. However, despite convincing methodological advantages in the detection of DNA-aneuploid subpopulations the clinical significance of cytokeratin gating of epithelial cells was only marginal. CONCLUSION DNA-ploidy has been shown to be as powerful or even more so in comparison to postoperative residual tumor in multivariate analysis for predicting clinical outcome in advanced ovarian cancer. Thus, determination of DNA-ploidy should be introduced to currently recruiting phase III studies for therapy of ovarian cancer for better definition of prognostic subgroups.
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Affiliation(s)
- Rainer Kimmig
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Munich, D-81377, Germany.
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Nagai N, Oshita T, Fujii T, Katsube Y, Matsubayashi S, Ohama K. Are DNA ploidy and epidermal growth factor receptor prognostic factors for untreated ovarian cancer? A prospective study. Am J Clin Oncol 2001; 24:215-21. [PMID: 11404488 DOI: 10.1097/00000421-200106000-00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To identify prognostic factors for untreated ovarian cancer, DNA ploidy, proliferative index (P.I.) and epidermal growth factor receptor (EGFR) expression were analyzed in a prospective series of 40 patients with ovarian cancer and 7 patients with borderline malignant ovarian tumor followed up for 5 years or more (median, 77 months). The frequency of aneuploid cells was 53.8% (21/39) in ovarian cancer and 14.3% (1/7) in borderline malignancy. There was no significant association between DNA ploidy and the clinicopathologic findings, in which aneuploid ovarian cancer was more common among advanced tumors. The S-phase fraction and P.I. value were higher in the patients with aneuploid tumors (p = 0.076). EGFR expression was detected in 76.9% (30/39) of ovarian cancers and 42.9% (3/7) of borderline malignant ovarian tumors, and the mean EGFR level was 5.8 +/- 12.1 (range: 0-49.5) and 28.3 +/- 71.1 (range: 0-189.4) fmol/mg protein, respectively. There was no correlation between EGFR expression and DNA ploidy, P.I., and clinicopathologic findings analyzed. The 5-year survival rate in patients with aneuploid tumors was significantly worse in patients with ovarian cancer (p = 0.0165, log-rank test). No significant relationship was shown between P.I., EGFR expression, and 5-year survival. Cox multivariate analysis showed that DNA ploidy, P.I., and EGFR expression are not associated with the risk of death (p = 0.5917, p = 0.9924, and p = 0.6840, respectively), although clinical stage shows a significant relationship (p = 0.0027). Our data showed that DNA ploidy is significantly related to the prognosis by univariate analysis, but DNA ploidy, P.I., and EGFR expression were not independent prognostic factors for the untreated ovarian cancer.
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Affiliation(s)
- N Nagai
- Department of Obstetrics and Gynecology, Hiroshima University Faculty of Medicine, Hiroshima, Japan
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4
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Fox H. Advances in the pathology of gynecologic cancer. Cancer Treat Res 1998; 95:353-76. [PMID: 9619291 DOI: 10.1007/978-1-4615-5447-9_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- H Fox
- Department of Pathological Sciences, University of Manchester, United Kingdom
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Brinkhuis M, Meijer GA, Baak JP. An evaluation of prognostic factors in advanced ovarian cancer. Eur J Obstet Gynecol Reprod Biol 1995; 63:115-24. [PMID: 8903765 DOI: 10.1016/0301-2115(95)02211-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A summary is presented of currently available prognostic factors in advanced ovarian cancer of the common epithelial types. The emphasis is on the most promising clinical, classical pathological, biochemical, immunohistochemical, molecular biological and quantitative pathological factors.
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Affiliation(s)
- M Brinkhuis
- Department of Pathology, Free University Hospital, Amsterdam, The Netherlands
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McGuckin MA, Hurst TG, Ward BG. Heterogeneity in production, secretion and glycosylation of MUC1 epithelial mucin by primary cultures of ovarian carcinoma. Int J Cancer 1995; 63:412-8. [PMID: 7591241 DOI: 10.1002/ijc.2910630319] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The MUC1 mucin produced by many adenocarcinomas has functions that may be of biological significance and is of importance clinically as a serum tumour marker and as a candidate target for immunotherapy. Previous studies of MUC1 production by ovarian cancers have been limited to immunohistochemical studies of tumour specimens and in vitro studies using cell lines. In this study the biosynthesis, secretion and glycosylation of MUC1 were studied in primary cultures of tumour cells obtained from 35 patients with stage 3 ovarian cancer. Although 34 of the 35 tumours produced MUC1 in vitro, the concentrations of intracellular and secreted MUC1, as measured by an ELISA using core protein-reactive antibodies, varied over a wide range. In addition, the amount of secreted MUC1 as a proportion of the intracellular concentration varied between tumours. Pulse/chase amino acid labelling studies of MUC1 biosynthesis also demonstrated variation in secretion rates. Multivariate regression analysis showed that of the variables tumour size, histological type, grade, ploidy status and intracellular and secreted MUC1 concentrations in vitro, only mucin secretion rate was significantly associated with serum mucin concentrations (p < 0.001). Culture of tumour cells for 4 days in the presence or absence of a competitive inhibitor of O-glycosylation, BAG, showed that the degree of glycosylation of MUC1 varied between tumours and that under-glycosylation was not correlated with production or secretion rates. Our study has shown heterogeneity in the production, secretion and glycosylation of MUC1 and a strong correlation between the secretion rate in vitro and the concentration in the serum of patients.
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Affiliation(s)
- M A McGuckin
- Department of Obstetrics and Gynaecology, University of Queensland, Royal Brisbane Hospital, Herston, Australia
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Kaern J, Tropé CG, Kristensen GB, Tveit KM, Pettersen EO. Evaluation of deoxyribonucleic acid ploidy and S-phase fraction as prognostic parameters in advanced epithelial ovarian carcinoma: a prospective study. Am J Obstet Gynecol 1994; 170:479-87. [PMID: 8116701 DOI: 10.1016/s0002-9378(94)70215-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Our goal was to study the prognostic value of deoxyribonucleic acid ploidy and S-phase fraction in advanced ovarian carcinoma. STUDY DESIGN Prognostic factors for corrected survival were evaluated in a prospective study including 169 patients with stage III and IV ovarian cancer treated between 1985 and 1990. RESULTS A total of 79% of the tumors were deoxyribonucleic acid aneuploid. Deoxyribonucleic acid aneuploidy was associated with grade of differentiation. S-phase fraction could be calculated in all deoxyribonucleic acid euploid tumors and 76% of the deoxyribonucleic acid aneuploid tumors. By multivariate analysis deoxyribonucleic acid ploidy, histologic type and grade, age, International Federation of Gynecology and Obstetrics stage, and amount of residual tumor were independent prognostic variables for corrected survival. On the basis of Cox regression a relative risk for the individual patient could be calculated. CONCLUSION Deoxyribonucleic acid ploidy gives additive prognostic information and is a useful parameter for dividing patients with advanced ovarian cancer into risk groups for treatment decisions.
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Affiliation(s)
- J Kaern
- Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo
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Khoo SK, Battistutta D, Hurst T, Sanderson B, Ward BG, Free K. The prognostic value of clinical, pathologic, and biologic parameters in ovarian cancer. Cancer 1993; 72:531-7. [PMID: 8319184 DOI: 10.1002/1097-0142(19930715)72:2<531::aid-cncr2820720233>3.0.co;2-f] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The prognosis in ovarian cancer remains poor, and there is a need to identify patients who are less likely to respond to treatment. METHODS In a study of 133 unselected patients with ovarian adenocarcinoma treated by a standard protocol, variables such as age, tumor type, International Federation of Gynecology and Obstetrics stage, cellular differentiation, amount of residual disease after surgery, and results from flow cytometry were correlated with survival and relapse at 24 months. RESULTS Although stage and cellular differentiation were found to be significant associations with survival and relapse, multivariate analyses identified only residual disease and ploidy status (and the related DNA index and percentage of aneuploid cells) as independent prognostic variables. The magnitude of the effect of ploidy depended on the amount of residual disease; among patients with less disease (< 2 cm), the mortality rate was nearly fourfold higher for those with aneuploid tumors than for those with diploid tumors. CONCLUSIONS Routine use of ploidy determination in ovarian cancer is an important prognostic indicator, especially for a subgroup of patients with minimal residual disease.
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Affiliation(s)
- S K Khoo
- Department of Obstetrics and Gynaecology, University of Queensland, Herston, Australia
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10
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Abstract
BACKGROUND Ovarian serous tumors of low malignant potential (STLMP) occasionally progress; a small percentage of patients die of the tumor. There is no known way to predict which tumors will progress. METHODS Forty STLMP were analyzed by DNA flow cytometry and compared with 26 serous carcinomas. RESULTS Forty percent of Stage I STLMP and 40% of Stage III STLMP were DNA aneuploid as compared to 54% of serous carcinomas. Aneuploidy was found in 50% of STLMP that progressed and in 38% of neoplasms that did not progress. Four of the 30 Stage I STLMP progressed, and 3 of the 4 were aneuploid; whereas, of the 26 Stage I STLMP that did not progress, 9 were DNA aneuploid. Stage III STLMP were aneuploid in 4 out of 10 instances (40%). Aneuploidy was not related to progression as three of four DNA diploid tumors progressed, and three of six that did not progress were aneuploid. Thirteen of 16 aneuploid STLMP had peridiploid aneuploid populations. The mean follow-up periods were 14.3 years for Stage I STLMP and 8.3 years for Stage III STLMP: CONCLUSIONS DNA aneuploidy in Stages I and III STLMP does not identify neoplasms likely to relapse with sufficient frequency to be useful in identifying those patients at high risk for relapse.
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Affiliation(s)
- J D Seidman
- Department of Gynecologic, Armed Forces Institute of Pathology, Washington, DC 20306-6000
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Abstract
BACKGROUND Despite recent advances in the treatment of ovarian cancer, the long-term prognosis for patients with this malignancy appears to depend more on tumor prognostic factors than on treatment regimens. The traditionally used prognostic factors are often subjective and, currently, have not been sufficient to determine individual patient prognosis. METHODS Newer techniques of quantitative cytologic testing, including flow cytometry, facilitate the objective evaluation of tumor cell heterogeneity and the identification of additional prognostic factors. RESULTS There is good evidence, mainly from retrospective studies, that DNA ploidy is a valuable prognostic indicator in patients with both early-stage and late-stage ovarian cancer. Most of the recent flow cytometric studies have identified ploidy as an independent prognostic factor, with aneuploidy predicting a significantly shorter survival time, even in patients with borderline malignant tumors. Flow cytometric determination of cell cycle information (e.g., S-phase fraction or proliferative index) may represent additional prognostic information and may be used to predict the early tumor response to treatment. CONCLUSIONS Although additional prospective studies are needed to establish the exact value of flow cytometric evaluation for ovarian cancer and other gynecologic malignancies, there is little doubt that the prognostic value of this information will influence clinical management of patients with these malignancies in the near future.
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Affiliation(s)
- P S Braly
- Department of Reproductive Medicine, University of California, San Diego 92103-8433
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Ward BG, McGuckin MA, Ramm LE, Coglan M, Sanderson B, Tripcony L, Free KE. The management of ovarian carcinoma is improved by the use of cancer-associated serum antigen and CA 125 assays. Cancer 1993; 71:430-8. [PMID: 8422635 DOI: 10.1002/1097-0142(19930115)71:2<430::aid-cncr2820710225>3.0.co;2-s] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The new tumor-associated mucin assay, cancer-associated serum antigen (CASA), was assessed with the CA 125 assay for use in the management of patients with epithelial ovarian cancer. METHODS CASA and CA 125 were assessed retrospectively for use in (1) monitoring 28 patients with Stage 3 or 4 ovarian carcinoma during therapy, (2) predicting the outcome of 41 second-look laparotomies (SLL), and (3) predicting the survival outcome by measuring these levels after surgery but before chemotherapy in 65 patients with Stage 3 disease. RESULTS Of 20 patients with recurrence after an initial response, the presence of CASA levels detected recurrence in 65% before clinical detection; CA 125, 50%; and the combination of CASA and CA 125, 80%. Six patients whose disease was in long-term remission did not have elevations of either marker. When used to predict the results of SLL, the positive predictive values of CASA and CA 125 were 77% and 100%, respectively. The negative predictive values for CASA and CA 125 were 71% and 66%, respectively. CASA detected 50% of positive SLL where microscopic disease only was found; the CA 125 test did not. Multivariate analysis of survival rates using levels of CASA and CA 125, age, residual disease, tumor type and grade, or the presence or absence of cisplatin in the chemotherapeutic regimen found that postoperative CASA levels ranked above all prognostic factors except age. CASA levels may be more accurate than surgical reporting of residual disease or they may define a subset of patients with biologically more aggressive ovarian carcinoma. CONCLUSIONS The CASA test is sensitive to ovarian carcinoma, and both CASA and CA 125 are more useful when used in conjunction.
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Affiliation(s)
- B G Ward
- Department of Obstetrics and Gynaecology, University of Queensland, Royal Brisbane Hospital, Herston, Australia
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Arakawa A. Study of the relationship between abnormalities in nuclear DNA and drug sensitivity of human gynecological cancer transplanted into nude mice. ASIA-OCEANIA JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1992; 18:397-405. [PMID: 1492812 DOI: 10.1111/j.1447-0756.1992.tb00336.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The relationship between abnormalities in nuclear DNA and anticancer-drug sensitivity of human gynecological cancer transplanted into nude mice is reported. Nuclear DNA content was expressed in terms of the DNA index (DI) and heterogeneity index score (HIS) using flow cytometry (FCM). Southern blot analysis was used to examine changes in DNA and in observed abnormal-size DNA fragments. Drug sensitivity was carried out according to a procedure described by Battelle Columbus Laboratories. The results were as follows: (1) Tumors with a high degree of DNA content were more sensitive to anticancer drugs than tumors with less DNA damage. (2) Severe heterogeneity of nuclear DNA caused drug resistance.
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Affiliation(s)
- A Arakawa
- Department of Obstetrics and Gynecology, Nagoya City University Medical School, Japan
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Jacoby AF, Young RH, Colvin RB, Flotte TJ, Preffer F, Scully RE, Swymer CM, Bell DA. DNA content in juvenile granulosa cell tumors of the ovary: a study of early- and advanced-stage disease. Gynecol Oncol 1992; 46:97-103. [PMID: 1634146 DOI: 10.1016/0090-8258(92)90203-u] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Paraffin-embedded tissue from 38 patients with early- and advanced-stage juvenile granulosa cell tumor (JGCT) of the ovary was analyzed by flow cytometry to investigate whether the DNA content is related to the histologic features, stage, or clinical outcome. Thirty-three cases were suitable for analysis: twenty-seven Stage Ia, two Stage Ic, and four Stage III. Eighteen (55%) tumors were DNA diploid and fifteen (45%) tumors were DNA aneuploid with a mean S-phase fraction (SPF) of 13.6% and a range of DNA indices from 1.0 to 2.2. Neither the DNA ploidy nor the SPF was associated with the stage of the disease. An analysis of the relation between DNA content and histopathologic features revealed that aneuploidy was associated with high mitotic rates and to a lesser extent with high-grade nuclear atypia. DNA aneuploidy was not associated with aggressive behavior of Stage Ia JGCTs. However, among the four patients with Stage III tumors, the two with diploid, low-SPF tumors were alive and well, whereas the two with aneuploid, high-SPF tumors developed recurrences or died. These data suggest that further studies on the prognostic significance of flow cytometric analysis of DNA content in advanced-stage JGCTs are warranted.
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Affiliation(s)
- A F Jacoby
- Department of Pathology, Harvard Medical School, Boston, Massachusetts
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Lage JM, Weinberg DS, Huettner PC, Mark SD. Flow cytometric analysis of nuclear DNA content in ovarian tumors. Association of ploidy with tumor type, histologic grade, and clinical stage. Cancer 1992; 69:2668-75. [PMID: 1571896 DOI: 10.1002/1097-0142(19920601)69:11<2668::aid-cncr2820691108>3.0.co;2-n] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The authors undertook a prospective, flow cytometric study of nuclear DNA ploidy in 140 fresh ovarian tumors. There were 43 benign tumors, 27 borderline tumors, and 70 malignant tumors. Results of DNA ploidy analysis were compared to age at diagnosis, menopausal status, tumor size, histologic type, grade, and International Federation of Gynecology and Obstetrics (FIGO) stage. Although the majority of benign tumors were diploid, 19% were aneuploid. Among the benign tumors, DNA ploidy was significantly associated with tumor type and tumor size. All borderline tumors were diploid. Of the 70 malignant tumors, 64% were aneuploid. In the malignant tumors, DNA aneuploidy had significant univariate associations with histologic type, grade, and FIGO stage. By multivariate analysis, DNA aneuploidy remained significantly associated with stage and grade, both known predictors of survival in ovarian cancer. These results indicate that DNA ploidy varies with the aggressive potential of an ovarian cancer and may, at the time of initial diagnosis, provide additional information about tumor prognosis.
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Affiliation(s)
- J M Lage
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
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Swenerton KD. Prognostic indices in ovarian cancer. Their significance in treatment planning. ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. SUPPLEMENT 1992; 155:67-74. [PMID: 1502892 DOI: 10.1111/j.1600-0412.1992.tb00009.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ovarian cancer exhibits a wide spectrum of behavior, the effectiveness of therapies varies and the circumstances of patients differ. Better outcomes will require more selective treatment strategies considerate of these variables. 1. The need for treatment As long as outcome is affected more by disease than by treatment, survival will be determined by the bulk and growth-rate of residual tumor-prognostic factors reflect these. They indicate the need for treatment, but not whether benefit is likely. FIGO stage is the international standard, but this alone is inadequately predictive. Grade reflects virulence, but subjectivity has limited its usefulness. Newer quantitative pathology techniques (such as DNA ploidy) more reproducibly reflect behavior. Prognostic factors can be used to define subsets of patients at differing degrees of disease risk. 2. Efficacy of treatment No response predictors are yet of practical use in selecting primary chemotherapy on an individual basis. Generally, response is more likely if the tumor is less extensive and if dose and treatment frequency are higher. Monitoring biomarkers can more quickly identify those with a suboptimal response who may require a change or discontinuation of treatment. Re-laparotomy has limited usefulness. Response predictors for second-line treatment (e.g. the failure-free interval) are available and also have implications for new drug testing. 3. Suitability of treatment Advanced age or serious additional illness may render intensive treatment inappropriate. The informed patient's wishes are of prime importance. An evolving strategy of selective management is described.
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Affiliation(s)
- K D Swenerton
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
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Ovarian Cancer. Hematol Oncol Clin North Am 1991. [DOI: 10.1016/s0889-8588(18)30385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Substantial progress has been made in understanding the biologic behavior of ovarian cancer and in assessing disease states and response to therapy with transvaginal sonography, CT scan, and tumor markers such as CA-125. There is no longer controversy regarding the importance and feasibility of adequate surgical staging, the need for cytoreduction, and the utility of cisplatin- or carboplatin-based combination chemotherapy in the management of patients with ovarian cancer. Increasing chemotherapy dose through escalated systemic doses or intraperitoneal administration, revising multidrug resistance, the use of biologic response modifiers, and the development of new methods of chemosensitivity testing may help improve the current 5-year survival rate of less than 30% for patients with stage III ovarian cancer. Significant improvement in screening tests and diagnostic capabilities will be necessary for a dramatic increase in survival.
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Affiliation(s)
- G Deppe
- Division of Gynecologic Oncology, Wayne State University School of Medicine, Hutzel Hospital, Detroit, Michigan
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