THE USES AND LIMITATIONS OF DNA FLOW-CYTOMETRY IN STAGE-IB OR II CERVICAL-CARCINOMA

Background. The role of flow cytometry in predicting prognosis for cer vical carcinoma remains unclear. Methods. Flow cytometric analysis was performed on tissues, fixed in formaldehyde solution and embedded in paraffin, from 411 patients with Stage IB or II cervical carcinoma who had been treated with radical abdominal hysterectomy and bilateral pe lvic lymphadenectomy. Results. DNA aneuploid-multiploid tumors were fo und in 37.5%, tetraploid in 4.6%, and diploid-peridiploid in 57.9%. Fi ve-year recurrence-free survival rates of the three groups were 74.3%, 77.8%, and 76.4%, respectively (P > 0.05). DNA aneuploidy and DNA ind ex (DI) of greater than 1.3 were highly correlated to parametria exten sion. In univariate analysis, pelvic lymph node metastases, stage, par ametrial extension, depth of cervical stromal invasion, tumor size, an d DI (1.3, 1.4, 1.5 as breakpoint) were significant prognostic factors . DNA ploidy, S-phase fraction, and S-G2M fraction were not significan t. In multivariate analysis, DI of greater than 1.3, pelvic node metas tases, clinical Stage II, and depth of stromal invasion greater than t wo-thirds of full cervical thickness were independent and significant variables. The prognostic index (PI), defined by the model, was able t o categorize the patients into three distinct risk groups. The 5-year recurrence free survival rates of the low-, intermediate-, and high-ri sk groups were 89.5%, 73.0%, and 58.9%, respectively (P = 0.0001). Con clusions. The prognostic value of the DI as a single variable is promi sing and warrants additional investigation to establish its appropriat e use.