Flow-cytometric DNA analysis of early stage adenocarcinoma of the cervix

Objective. The purpose of this study was to determine the utility of DNA fl ow cytometry as a prognostic indicator for risk of recurrence and overall s urvival in patients with early stage adenocarcinomas of the uterine cervix. Methods. DNA how cytometry was performed to determine ploidy, DNA index, an d proliferative index in 66 women with stages IB and IIA pure mucinous aden ocarcinomas of the cervix treated by primary surgical therapy with radical hysterectomy and pelvic lymphadenectomy. Fifty-seven of 66 (86.3%) tissue s amples were analyzable. Three sections were obtained from paraffin-embedded tissue blocks containing primary tumor. Flow-cytometric results, along wit h other known prognostic variables for risk for recurrent disease and survi val, were analyzed using Cox regression proportional hazards model, and sur vival curves were generated by the Kaplan-Meier method. Results. Of 57 interpretable samples, DNA ploidy patterns were 18 (27%) dip loid, 8 (12%) tetraploid, and 31 (47%) aneuploid, Thirteen of 66 patients ( 20%) experienced recurrence with a median time to recurrence of 1.6 years, No significant correlation was noted between DNA ploidy and risk of recurre nce (P = 0.429). Multivariate analysis confirmed that positive metastatic l ymph nodes were associated with risk of recurrence (P < 0.001), In node-neg ative patients, a high proliferative index (S% + G(2)M% > 20%), measured as a continuous variable, was the only significant factor for tumor recurrenc e (P = 0.002). Conclusion. DNA ploidy does not predict a patient's risk for tumor recurren ce; however, a high proliferative index value warrants further investigatio n as a potential prognostic indicator for risk of recurrent disease in pati ents with adenocarcinoma of the uterine cervix. (C) 1999 Academic Press.