Genest D R, Sheets E, Lage J M
Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115.
Am J Clin Pathol. 1994 Sep;102(3):341-8. doi: 10.1093/ajcp/102.3.341.
Flow-cytometric studies have demonstrated that DNA aneuploidy and proliferative activity are independent prognostic factors in endometrial carcinoma. The authors performed flow-cytometric analysis of the nuclear DNA content of 46 fresh endometrial adenocarcinomas to investigate tumor DNA ploidy and cell-cycle kinetics in relation to histologic features with known prognostic significance, mitotic activity (assessed quantitatively), and clinical features suggestive of hyperestrogenism. Thirty-five tumors (76%) were DNA-diploid, and 11 (24%) were DNA-aneuploid. DNA aneuploidy correlated significantly with two histologic features: high cytologic grade (P < .027) and five or more atypical mitoses per 50 high-power fields (P < .001). The presence of one or more atypical mitosis per 50 high-power fields, evaluated independent of DNA ploidy, was associated with stage III or IV tumors (P < .015). A low proliferative index correlated with tumors with grade 1 architecture (P < .006) and grade 1 or 2 cytology (P < .017); a high proliferative index correlated with vascular invasion by tumor (P < .027). DNA ploidy and proliferative activity did not correlate with any feature indicative of estrogenic status including age, parity, menopausal status, obesity, hypertension, diabetes, exogenous estrogen use, or endometrial hyperplasia. Therefore, in endometrial adenocarcinoma, estrogenic status does not correlate with DNA ploidy or proliferative activity; proliferative activity correlates with tumor grade; and atypical mitoses appear to be highly associated with both DNA aneuploidy and advanced tumor stage, and as such, may identify tumors with a poor prognosis.
流式细胞术研究表明，DNA非整倍体和增殖活性是子宫内膜癌独立的预后因素。作者对46例新鲜子宫内膜腺癌的核DNA含量进行了流式细胞术分析，以研究肿瘤DNA倍体和细胞周期动力学与具有已知预后意义的组织学特征、有丝分裂活性（定量评估）以及提示高雌激素状态的临床特征之间的关系。35例肿瘤（76%）为DNA二倍体，11例（24%）为DNA非整倍体。DNA非整倍体与两个组织学特征显著相关：高细胞分级（P < 0.027）和每50个高倍视野中有5个或更多非典型有丝分裂（P < 0.001）。每50个高倍视野中存在1个或更多非典型有丝分裂，在独立于DNA倍体进行评估时，与Ⅲ期或Ⅳ期肿瘤相关（P < 0.015）。低增殖指数与1级结构的肿瘤相关（P < 0.006）和1级或2级细胞学的肿瘤相关（P < 0.017）；高增殖指数与肿瘤血管浸润相关（P < 0.027）。DNA倍体和增殖活性与任何提示雌激素状态的特征均无相关性，这些特征包括年龄、产次、绝经状态、肥胖、高血压、糖尿病、外源性雌激素使用或子宫内膜增生。因此，在子宫内膜腺癌中，雌激素状态与DNA倍体或增殖活性无关；增殖活性与肿瘤分级相关；非典型有丝分裂似乎与DNA非整倍体和晚期肿瘤阶段均高度相关，因此，可能识别出预后不良的肿瘤。
