RELATIONSHIP OF NONSTAGING PATHOLOGICAL RISK-FACTORS TO LYMPH-NODE METASTASIS AND RECURRENCE IN CLINICAL STAGE-I ENDOMETRIAL CARCINOMA

Objective. To determine if DNA ploidy, hormone receptors, vascular spa ce invasion (VSI), perivascular lymphocytes (PVL), and the oncogenes H ER-2/neu, p53, and bcl-2 are independent prognostic indicators for lym ph node metastasis and cancer recurrence in clinical stage I endometri al carcinoma. Methods. Among 349 patients with clinical stage I endome trial cancer 31 patients either had lymph node metastases when surgica lly staged or developed recurrent cancer. Using a case-control matched -pair technique, controls were selected for each of 24 cases by matchi ng for age, histological grade, depth of myometrial invasion, performa nce of node dissection, and use of adjuvant radiation therapy. In a bl inded fashion a pathologist reviewed all histopathology, and all molec ular tests were performed on paraffin-embedded tissue samples. Statist ical analysis was performed by chi(2) and McNemar's tests. Results. VS I was the only histopathological factor significantly related to posit ive lymph nodes and cancer recurrence (P = 0.01), independent of grade and myometrial invasion. Aneuploidy, oncogene expression (p53, HER-2/ neu, bcl-2), and hormone receptors were not significantly related to l ymph node metastasis and cancer recurrence. Conclusions. The presence of vascular space invasion is a pathological factor independently asso ciated with a risk of nodal metastasis and cancer recurrence in clinic al stage I endometrial cancer. DNA ploidy, oncogene expression, and ho rmone receptor status do not have more predictive value than standard staging pathological criteria. (C) 1997 Academic Press.