CARCINOMA OF THE ENDOMETRIUM - DO THE NUCLEAR GRADE AND DNA-PLOIDY PROVIDE MORE PROGNOSTIC INFORMATION THAN DO THE FIGO AND WHO CLASSIFICATIONS

The aim of this study was to compare the World Health Orgazization (WH O), the International Federation of Gynecology (FIGO), and nuclear gra ding systems and to evaluate their reproducibility, as well as their p rognostic impact, in relation to clinical variables and DNA ploidy. Th e study comprised 266 women with endometrial carcinoma in clinical sta ges I-IV. Low-risk patients, i.e., patients with grade 1-2 tumors in c linical stage I, were generally not included. In univariate Cox analys es, WHO, FIGO, and especially nuclear grading (p < 0.001), as well as age, stage, and ploidy, were prognostic regarding survival. In the mul tivariate Cox analyses, WHO and FIGO grades yielded little further ind ependent information beyond nuclear grade. When DNA ploidy was added t o the analyses, nuclear grade lost most of its impact because aneuploi dy was a powerful factor (p < 0.001) that covaried with nuclear grade. The WHO, FIGO, and nuclear grading systems were found to be subjectiv e, with correlation coefficients of similar to 0.60 between different pathologists. Age, stage, and aneuploidy were the most important predi ctors of outcome in the multivariate analyses. Nuclear grade was a str ong prognostic factor in the univariate analyses and a more important indicator than the commonly used histopathological grading systems.