Ah. Wolfson et al., A MULTIVARIATE-ANALYSIS OF CLINICOPATHOLOGICAL FACTORS FOR PREDICTINGOUTCOME IN UTERINE SARCOMAS, Gynecologic oncology, 52(1), 1994, pp. 56-62
This study involved a comprehensive review of the histologic slides of
62 patients who were diagnosed with uterine sarcoma from 1978 through
1988 at a single institution. In addition, DNA content (ploidy level)
could be determined from the H & E slides of these tumors using image
analysis. Also, 42 of these cases had retrievable cell blocks on whic
h DNA analysis was performed by means of flow cytometry. A linear regr
ession analysis found a high degree of correlation (r = 0.8) between t
he measurement of the DNA index of these tumors by these two technique
s. All cases were retrospectively restaged using the newly adopted FIG
O surgical staging criteria which found the following distribution: 22
(35.5%) Stage I, 10 (16.1%) Stage II, 12 (19.4%) Stage III, and 18 (2
9%) Stage IV. A multivariate analysis of 60 evaluable patients using t
he Cox proportional hazard model found that surgical staging was the m
ost significant prognostic factor with respect to the endpoint of over
all survival (P = 0.00004). Both patient age at diagnosis and mitotic
index were independent from surgical staging in predicting outcome. Fu
rthermore, there was a trend suggesting that DNA index also had progno
stic value. Of particular interest was that patients with diploid tumo
rs (DNA index, 0.9-1.1) had a 5-year overall survival of 72% and did n
ot approach median survival; however, hyperdiploid tumors (DNA index >
1.1) and hypodiploid tumors (DNA index <0.9) were associated with medi
an survivals of 18 and 12 months, respectively. In conclusion, this st
udy supports the use of surgical staging of patients with uterine sarc
omas in order to optimally determine their chance for survival. Furthe
r biologic investigations which may result in identifying those patien
ts who could benefit from adjunctive treatment are recommended. (C) 19
94 Academic Press, Inc.