PROGNOSTIC VALUE OF FLOW CYTOMETRIC DEOXYRIBONUCLEIC-ACID INDEX IN ENDOMETRIAL CARCINOMA - COMPARISON WITH OTHER CLINICAL-PATHOLOGICAL PARAMETERS

OBJECTIVE: The aims of the current study were to verify the impact of flow cytometric deoxyribonucleic acid index on clinical outcome in end ometrial carcinoma and to assess whether its value is independent from the other clinical-pathologic features. STUDY DESIGN: In a prospectiv e series 74 cases of endometrial carcinoma with surgery performed at o ur institution were studied. Flow cytometry was performed on fresh tum or samples. The median follow-up period was 31 months (range 8 to 52). Disease-free survival and actuarial survival were the end points of t he study. RESULTS: Among the 74 patients (53 with diploid and 21 with aneuploid tumors) there were 14 recurrences and 10 deaths caused by th e disease. The recurrence rate was 7.5% for the diploid and 47.6% for the aneuploid tumors (p < 0.001). Mortality was 3.8% for diploid and 3 8% for aneuploid cases (p < 0.001). Disease-free survival was 89.1% in the former group and 36.3% in the latter. Actuarial survival (Kaplan- Meier method) was 94.7% and 49.5%, respectively. Deoxyribonucleic acid index, stage (international Federation of Gynecology and Obstetrics), and grade of differentiation were significantly correlated with survi val, whereas age, depth of myometrial invasion, and histologic type we re not. in a multivariate analysis (Cox proportional hazards) deoxyrib onucleic acid index was the strongest independent predictor of clinica l outcome, followed by International Federation of Gynecology and Obst etrics stage, whereas grade of differentiation yielded no independent prognostic information. CONCLUSIONS: The flow cytometric deoxyribonucl eic acid index is an important independent prognosticator, and its det ermination should be included in the standard management of endometria l cancer.