PROLIFERATING CELL NUCLEAR ANTIGEN IN ENDOMETRIAL CARCINOMA - PRETREATMENT IDENTIFICATION OF HIGH-RISK PATIENTS

Objective: The aim of our study was to retrospectively examine the pro liferating cell nuclear antigen (PCNA) immunoreactivity of tumor cells in curettage specimens containing endometrioid adenocarcinoma and obt ained immediately before definitive surgical staging. This PCNA index was compared with the one subsequently derived from surgical specimens and assessed as a function of histologic grade, depth of myometrial i nvasion, neoplastic nodal involvement, cervical spread, and progressio n-free survival in order to determine a new prognostic parameter valua ble at the time of diagnosis. Materials and methods: A population of 7 9 patients with locally advanced (stage I and II) endometrioid carcino ma, who underwent both the preliminary diagnostic curettage and the su bsequent definitive surgical management, selected from January 1986 to June 1993 at the Department of Gynecology and Obstetrics, Ancona Univ ersity, was retrospectively recruited from our series of 99 endometria l carcinomas. The archival paraffin blocks from the curettage and uter ine specimens were identified and assessed for histologic reexaminatio n and PCNA immunostaining [PC10 monoclonal antibody (Dako, Denmark)]. Results: After a median follow-up of 47 months, recurrences were detec ted in 7 cases, and the Kaplan-Meier disease-free survival curve estim ated for the entire study group was 91%. The median PCNA index of the curettage specimens presented a good overlap with the PCNA immunostain ing in corresponding uterine samples with a correlation coefficient of 0.4 (P = 0.02). A PCNA index greater than or equal to 30% in curettag e specimen was predictive of deep myometrial invasion; of 35 patients with PCNA index greater than or equal to 30%, 29 (83%) had myometrial invasion greater than or equal to 50%. No significant relationship was observed with neoplastic cervical spread, and histologic differentiat ion. By Cox hazard analysis, the PCNA index evaluated on curettage spe cimens was significantly related to disease-free survival, with signif icant disease-free survival advantages for patients with PCNA <30% (P< 0.001). Conclusion: Our findings suggest that the PCNA immunostaining has proved to be considerably promising for the risk assessment in loc ally advanced endometrial carcinoma. The PCNA index is an objective an d reproducible parameter accruably valuable also before starting the t reatment; in presence of a high PCNA index, the patients should be ref erred to gynecologic oncologists for appropriate management. (C) 1996 Academic Press, Inc.