Susini T, Rapi S, Savino L, Boddi V, Berti P, Massi G
Obstetrics and Gynecology Department, Florence University, Italy.
Am J Obstet Gynecol. 1994 Feb;170(2):527-34. doi: 10.1016/s0002-9378(94)70222-5.
The aims of the current study were to verify the impact of flow cytometric deoxyribonucleic acid index on clinical outcome in endometrial carcinoma and to assess whether its value is independent from the other clinical-pathologic features.
In a prospective series 74 cases of endometrial carcinoma with surgery performed at our institution were studied. Flow cytometry was performed on fresh tumor samples. The median follow-up period was 31 months (range 8 to 52). Disease-free survival and actuarial survival were the end points of the study.
Among the 74 patients (53 with diploid and 21 with aneuploid tumors) there were 14 recurrences and 10 deaths caused by the disease. The recurrence rate was 7.5% for the diploid and 47.6% for the aneuploid tumors (p < 0.001). Mortality was 3.8% for diploid and 38% for aneuploid cases (p < 0.001). Disease-free survival was 89.1% in the former group and 36.3% in the latter. Actuarial survival (Kaplan-Meier method) was 94.7% and 49.5%, respectively. Deoxyribonucleic acid index, stage (International Federation of Gynecology and Obstetrics), and grade of differentiation were significantly correlated with survival, whereas age, depth of myometrial invasion, and histologic type were not. In a multivariate analysis (Cox proportional hazards) deoxyribonucleic acid index was the strongest independent predictor of clinical outcome, followed by International Federation of Gynecology and Obstetrics stage, whereas grade of differentiation yielded no independent prognostic information.
The flow cytometric deoxyribonucleic acid index is an important independent prognosticator, and its determination should be included in the standard management of endometrial cancer.
本研究旨在验证流式细胞术检测的脱氧核糖核酸指数对子宫内膜癌临床结局的影响，并评估其数值是否独立于其他临床病理特征。
对在本机构接受手术的74例子宫内膜癌患者进行前瞻性研究。对新鲜肿瘤样本进行流式细胞术检测。中位随访期为31个月（范围8至52个月）。无病生存期和精算生存率为研究终点。
74例患者中（53例为二倍体肿瘤，21例为非整倍体肿瘤），有14例复发，10例死于该疾病。二倍体肿瘤的复发率为7.5%，非整倍体肿瘤为47.6%（p<0.001）。二倍体病例的死亡率为3.8%，非整倍体病例为38%（p<0.001）。前一组的无病生存率为89.1%，后一组为36.3%。精算生存率（Kaplan-Meier法）分别为94.7%和49.5%。脱氧核糖核酸指数、分期（国际妇产科联合会）和分化程度与生存率显著相关，而年龄、肌层浸润深度和组织学类型则不然。在多变量分析（Cox比例风险模型）中，脱氧核糖核酸指数是临床结局最强的独立预测因素，其次是国际妇产科联合会分期，而分化程度未产生独立的预后信息。
流式细胞术检测的脱氧核糖核酸指数是一个重要的独立预后指标，其测定应纳入子宫内膜癌的标准管理中。
