Zaino R J, Davis A T, Ohlsson-Wilhelm B M, Brunetto V L
Department of Pathology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.
Int J Gynecol Pathol. 1998 Oct;17(4):312-9. doi: 10.1097/00004347-199810000-00004.
The identification of prognostic variables is an important aspect of managing and counseling women with endometrial adenocarcinoma. The surgical stage, age, cell type, depth of myometrial invasion, and histologic grade have all been previously demonstrated to be related to prognosis. Several reports have indicated that tumor ploidy as determined by flow cytometry with fresh or fixed cells removed from paraffin blocks of endometrial adenocarcinomas can contribute to the assessment of prognosis. To verify the significance of DNA content in endometrial adenocarcinoma, we conducted an historical cohort study on a subgroup of women from a Gynecologic Oncology Group (GOG) protocol of early clinical stage disease. Flow cytometry was performed at one facility on cells extracted from blocks obtained from several GOG member institutions. Blocks were submitted for 293 of 933 eligible patients. Ninety-two histograms were of good quality, with 55 interpreted as diploid and 37 as aneuploid. One hundred sixty-two histograms were technically suboptimal, of which 137 were considered probably diploid, 13 probably aneuploid, and 12 unacceptable due to high background noise. Of the commonly accepted prognostic variables, only depth of invasion was significantly related to the ploidy status. There was no discernable difference in survival between patients with diploid and patients with probable diploid and probable aneuploid tumor types. Incorporation of the flow cytometry data into a proportional hazards regression model adjusted for age and surgical stage revealed a significant increased risk of disease-related death (relative risk, 4.1; 95% confidence interval, 2.3 to 7.3) for patients with aneuploid tumor type as compared to patients with diploid tumor type. This study confirms the prognostic significance of ploidy determination by flow cytometry and also indicates some of the difficulties of retrospectively applying this technology to cooperative group studies.
确定预后变量是子宫内膜腺癌女性患者管理和咨询工作的一个重要方面。手术分期、年龄、细胞类型、肌层浸润深度和组织学分级先前均已证明与预后相关。有几份报告指出，通过流式细胞术测定从子宫内膜腺癌石蜡块中取出的新鲜或固定细胞的肿瘤倍性，有助于评估预后。为了验证DNA含量在子宫内膜腺癌中的意义，我们对妇科肿瘤学组（GOG）一项早期临床期疾病方案中的一组女性患者进行了一项历史性队列研究。在一个机构对从几个GOG成员机构获得的石蜡块中提取的细胞进行了流式细胞术检测。933例符合条件的患者中有293例提交了石蜡块。92份直方图质量良好，其中55份被解释为二倍体，37份为非整倍体。162份直方图在技术上欠佳，其中137份可能被认为是二倍体，13份可能是非整倍体，12份因背景噪声过高而不可接受。在公认的预后变量中，只有浸润深度与倍性状态显著相关。二倍体患者与可能为二倍体和可能为非整倍体肿瘤类型的患者在生存率上没有明显差异。将流式细胞术数据纳入根据年龄和手术分期进行调整的比例风险回归模型后发现，与二倍体肿瘤类型的患者相比，非整倍体肿瘤类型的患者疾病相关死亡风险显著增加（相对风险，4.1；95%置信区间，2.3至7.3）。这项研究证实了通过流式细胞术测定倍性的预后意义，也指出了将这项技术回顾性应用于合作组研究的一些困难。
