A high ratio of apoptosis to proliferation correlates with improved survival after radiotherapy for cervical adenocarcinoma

Purpose: A retrospective study was made of the role of apoptosis in determi ning radiotherapy outcome in 39 adenocarcinoma of the cervix, A comparison was also made of the detection of apoptosis by morphology and the TdT dUtp nick end-labeling (TUNEL) assay. Methods and Materials: The level of apoptosis was assessed in paraffin-embe dded sections by cell morphology, the TUNEL assay, and a combination of the two. A total of 2,000 cells were counted per section, to obtain apoptotic (AI) and mitotic (MI) indices. Results: Patients with a high AI had a higher survival rate than those with a low AI, however, the difference was not significant. Using a ratio of ap optosis to proliferation indices, patients with an AI:MI > median had signi ficantly better survival than those with AI:MI < median. This was true wher e the AI was quantified by morphology alone (p = 0.030) or in combination w ith the TUNEL assay (p = 0.008), Where the AI was quantified by a combinati on of morphology and TUNEL, the 5-year survival rates for women with AI:MI greater or less than the median were 81% and 25%, respectively. Conclusion: A high ratio of AI:MI in adenocarcinoma of the cervix indicates a good prognosis. A combination of the TUNEL assay and morphology provided the best discrimination between outcome groups. (C) 1999 Elsevier Science Inc.