Pretreatment assessment of prognostic indicators in endometrial cancer

OBJECTIVE: The object of this study was to assess the association of histol ogic, cytokinetic, and molecular variables in preoperative endometrial samp les with extrauterine disease, recurrence, and survival among patients with endometrial cancer. STUDY DESIGN: In a case-cohort study of 125 women, ploidy, S-phase fraction , proliferative index. deoxyribonucleic acid index, proliferating cell nucl ear antigen, MIB-1 proliferation marker, p53 tumor suppressor gene, and cyt oplasmic HER-2/neu oncogene and bet-2 expressions were quantitated. RESULTS: A model with only one independent term predicted progression-free survival; that variable was p53 (P < .0001; relative risk, 5.60). A model w ith two independent terms predicted disease-related survival; these variabl es were p53 (P = .0002; relative risk, 7.39) and MIB-1 (P = .03; relative r isk, 3.217). Among patients with tumors with both p53 and MIB-1 expression exceeding 33%, a total of 32% had died of disease by 2 years. A model for p redicting extrauterine disease selected two independent variables: p53 (odd s ratio, 3.20; P = .01) and ploidy (odds ratio, 2.16; P = .04). An advanced surgical stage was encountered in 26% to 35%:, of cases in which either th e p53 expression exceeded 33% or the deoxyribonucleic acid content was nond iploid and in 53% of cases in which both variables were unfavorable. CONCLUSIONS: Preoperative evaluation of quantifiable cytokinetic and molecu lar variables can assist in identifying tumor types that are predisposed to ward a more aggressive clinical course.