一项关于倍性在子宫内膜癌中预后作用的前瞻性研究的十年结果：DNA非整倍体在所谓“低风险”的高分化和中分化肿瘤患者中识别出高风险病例。

Ten-year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma: dNA aneuploidy identifies high-risk cases among the so-called 'low-risk' patients with well and moderately differentiated tumors.

作者信息

Susini Tommaso, Amunni Gianni, Molino Cecilia, Carriero Carlo, Rapi Stefano, Branconi Francesco, Marchionni Mauro, Taddei Gianluigi, Scarselli Gianfranco

机构信息

Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.

出版信息

Cancer. 2007 Mar 1;109(5):882-90. doi: 10.1002/cncr.22465.

DOI:10.1002/cncr.22465

PMID:17262824

Abstract

BACKGROUND

To improve the outcome of endometrial cancer patients, a more accurate prognostic assessment is mandatory. The aims of the study were to evaluate the role of flow cytometric DNA ploidy as an independent prognostic factor in patients with endometrial cancer and to verify if ploidy was able to distinguish patients with different prognosis into homogeneous subgroups for grade of differentiation and stage.

METHODS

In a prospective study, DNA ploidy was evaluated from fresh tumor samples in 174 endometrial cancer patients who underwent surgery as the first treatment. Ploidy, as well as classical parameters, were analyzed in relation to the length of disease-free survival and disease-specific survival.

RESULTS

DNA aneuploidy was found in 49 patients (28.2%). Patients with DNA-aneuploid tumors had a significantly reduced disease-free interval and disease-specific survival (P < .0001). The 10-year survival probability was 53.2% for DNA-aneuploid patients and 91.0% for patients with DNA-diploid tumors. By multivariate analysis DNA-aneuploid type was the strongest independent predictor of poor outcome, followed by age and stage. Patients with DNA-aneuploid tumor had a significantly higher risk ratio for recurrence (5.03) and death due to disease (6.50) than patients with DNA-diploid tumors. Stratification by DNA-ploidy within each group by grade of differentiation allowed identification of patients with significantly different outcome. In grade 2 tumors, 10-year survival was 45.0% in aneuploid cases and 91.9% in diploid cases (P < .0001). Patients with advanced-stage (>I) diploid tumor did significantly better than patients with stage I aneuploid tumor (P = .04).

CONCLUSIONS

The presence of DNA-aneuploid type in endometrial cancer identifies high-risk cases among the patients considered 'low risk' according to stage and grade of differentiation.

摘要

背景

为改善子宫内膜癌患者的治疗效果，必须进行更准确的预后评估。本研究的目的是评估流式细胞术DNA倍体作为子宫内膜癌患者独立预后因素的作用，并验证倍体是否能够根据分化程度和分期将预后不同的患者分为同质亚组。

方法

在一项前瞻性研究中，对174例接受手术作为首次治疗的子宫内膜癌患者的新鲜肿瘤样本进行了DNA倍体评估。分析了倍体以及经典参数与无病生存期和疾病特异性生存期的关系。

结果

49例患者（28.2%）检测到DNA非整倍体。DNA非整倍体肿瘤患者的无病间期和疾病特异性生存期显著缩短（P <.0001）。DNA非整倍体患者的10年生存概率为53.2%，DNA二倍体肿瘤患者为91.0%。多因素分析显示，DNA非整倍体类型是预后不良的最强独立预测因素，其次是年龄和分期。与DNA二倍体肿瘤患者相比，DNA非整倍体肿瘤患者的复发风险比（5.03）和疾病死亡风险比（6.50）显著更高。根据分化程度在每组内按DNA倍体分层可识别出预后显著不同的患者。在2级肿瘤中，非整倍体病例的10年生存率为45.0%，二倍体病例为91.9%（P <.0001）。晚期（>I期）二倍体肿瘤患者的预后明显优于I期非整倍体肿瘤患者（P = 0.04）。