The evaluation of proliferative activity in CINIII and microinvasive cervical cancer and its role in recurrence

Objective: To evaluate the proliferation activity in CIN III lesions and Ia 1 carcinoma according to the risk of recurrence. Study. design: The prolife ration markers PCNA (proliferating cell nuclear antigen) and mitotic index were studied in 75 patients with CIN III and in 20 patients with an Ial squ amous carcinoma of the cervix by staining representative tissue sections fo r the PCNA and assessing the mitotic index. Associations between the studie d proliferation markers and various histopathologic characteristics as well as recurrence were assessed. Results : Three groups of PCNA were constitut ed: <20, 20-40. <greater than or equal to>40% positive tumour nuclei, which contained, respectively, 45 (47%). 29 (31%). and 21 (22%) patients. Microi nvasive carcinomas have a higher proliferation activity than CIN III (PCNA P=0.005; mitotic index P=0.094). For CIN III, there was a significantly low er risk for recurrence in the group with lower mitotic activity, compared t o the group with higher mitotic activity (Kaplan-Meier: log-rank testing P= 0.044). Significance was, however, not reached for the different PCNA categ ories (Kaplan-Meier, log-rank test P=0.068). Multiple regression analysis s howed that in our population of CIN III lesions, only age of diagnosis and treatment modality were relevant (independent) prognostic indicators fur re currence. Conclusions: In CIN III lesions there is evidence for an associat ion between proliferation activity and the risk of recurrence. The observed crude association weakens when adjusting for age at diagnosis and treatmen t modality. Apparently this feature is: associated with more aggressive bio logical behaviour and could be used to identify women who are at higher ris k of recurrence. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved .