Flow cytometric DNA analysis of early stage adenocarcinoma of the cervix

Objective. The aim of this study was to determine the utility of DNA flow c ytometry as a prognostic indicator for risk of recurrence and overall survi val in patients with early stage adenocarcinomas of the uterine cervix. Methods. DNA flow cytometry was performed to determine ploidy, DNA index, a nd proliferative index in 66 women with stage HE 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 the Cox regression proportional hazards model and survival curves generated by the Kaplan-Meier method. Results. Of 57 interpretable samples, DNA ploidy patterns were Is (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.