A MULTIVARIATE-ANALYSIS OF CLINICOPATHOLOGICAL FACTORS FOR PREDICTINGOUTCOME IN UTERINE SARCOMAS

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.