Ⅰ期子宫内膜癌中 DNA 倍体的预后意义。

Prognostic significance of DNA ploidy in stage I endometrial cancer.

机构信息

Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea.

出版信息

Gynecol Oncol. 2011 Jul;122(1):79-82. doi: 10.1016/j.ygyno.2011.03.017. Epub 2011 Apr 13.

DOI:10.1016/j.ygyno.2011.03.017

PMID:21492921

Abstract

OBJECTIVE

To improve the outcome for patients with endometrial cancer, a more accurate prognostic assessment is needed. The current study was undertaken to determine the role of flow cytometric DNA ploidy as an independent prognostic factor in patients with stage I endometrial cancer and to verify if ploidy is able to identify high-risk cases among the apparent 'low-risk' patients, defined as stage (IA), grade (1 or 2), and histologic type (endometrioid).

METHODS

This was a retrospective study. DNA ploidy was evaluated from tumor samples in 217 patients with stage I endometrial cancer who underwent definitive surgery as the first treatment between 2003 and 2009. Ploidy and other classic parameters were analyzed in relation to the length of recurrence-free survival.

RESULTS

Among the 217 evaluated patients, 184 (84.8%) had diploid tumors and 33 (15.2%) had aneuploid tumors. There were 12 recurrences during the median follow-up intervals of 42.7 months. Stage, grade, histologic type, lymphovascular space invasion (LVSI), and ploidy were significantly correlated with recurrence-free interval by univariate Cox analysis. Based on multivariate Cox analysis, ploidy was an independent prognostic factor, with a hazard ratio of 4.5 (95% confidence interval [CI], 1.3-15.3; P=0.017) adjusted for stage, grade, histologic type, and LVSI. In low-risk patients (n=156), the recurrence rate was 2.1% for diploid tumors and 12.5% for aneuploid tumors (P=0.038).

CONCLUSIONS

DNA aneuploidy is an independent prognostic factor in patients with endometrial cancer and can identify high-risk patients among those considered 'low-risk' with stage I endometrial cancer.

摘要

目的

为了改善子宫内膜癌患者的预后，需要更准确的预后评估。本研究旨在确定流式细胞术 DNA 倍性作为 I 期子宫内膜癌患者独立预后因素的作用，并验证倍性是否能够识别出看似“低危”（IA 期、G1 或 G2 级和组织学类型为子宫内膜样）患者中的高危病例。

方法

这是一项回顾性研究。对 2003 年至 2009 年间接受确定性手术作为一线治疗的 217 例 I 期子宫内膜癌患者的肿瘤样本进行 DNA 倍性评估。分析倍性和其他经典参数与无复发生存时间的关系。

结果

在 217 例评估患者中，184 例（84.8%）肿瘤为二倍体，33 例（15.2%）肿瘤为非整倍体。在中位随访 42.7 个月期间，有 12 例患者复发。单因素 Cox 分析显示，分期、分级、组织学类型、脉管间隙浸润（LVSI）和倍性与无复发生存时间显著相关。基于多因素 Cox 分析，倍性是独立的预后因素，风险比为 4.5（95%置信区间[CI]，1.3-15.3；P=0.017），调整了分期、分级、组织学类型和 LVSI。在低危患者（n=156）中，二倍体肿瘤的复发率为 2.1%，非整倍体肿瘤的复发率为 12.5%（P=0.038）。