Prognostic Factors In Endometrial Carcinoma Research Articles

Thrombocytosis as a Prognostic Factor in Endometrial Carcinoma

We reviewed the prevalence of thrombocytosis (platelet count ≥400,000/μL) and its association with outcome in 135 consecutive endometrial carcinoma patients and compared the platelet count with other prognostic factors. Nineteen of 135 patients (14%) had thrombocytosis. Thrombocytosis was significantly more frequent in advanced disease (stage II–IV), unfavorable grade (G2 and G3), deep myometrial invasion, and lymph–vascular space invasion. The overall 5-year survival rate was 92%. The 5-year survival rate of the 19 patients with thrombocytosis was significantly worse than that of the patients without thrombocytosis (61 vs 96%,P< 0.0001). The recurrence rate was significantly higher in patients with thrombocytosis than in those with a platelet count <400,000/μL (7 vs 32%,P< 0.005). In a multivariate analysis, thrombocytosis continued to be a predictor of worse prognosis. In conclusion, we found thrombocytosis to be a prognostic factor for survival in patients with endometrial carcinoma.

Reliability of preoperative evaluation of prognostic factors in endometrial carcinoma

Objective: To define the accuracy of preoperative evaluation of prognostic factors in detecting patients with low risk of node metastasis in which different surgical approaches can be proposed. Subjects: Seventy-five patients with a histologically proven endometrial carcinoma were considered in this study. Methods: All the patients underwent a preoperative evaluation of grading (G), and myometrial invasion (M) by endometrial biopsy and transvaginal ultrasound (TVS). In 41 patients preoperative ploidy of carcinoma cells (P) was determined by flow cytometry. Pre-surgical G, M and P were then compared with surgical specimens. We considered ‘low risk’, patients with no or moderate myometrial invasion, well-differentiated histological grading and diploid DNA. Results: We were able to identify 19 23 (82.6%) low risk cases. Correct identification of high risk patients was obtained in 49 52 (94%) patients. In three low risk patients, correctly diagnosed preoperatively, the final FIGO stage was IIIA (two for adnexal involvement and one for positive peritoneal washing). Conclusions: Our findings suggest that it is possible to detect preoperatively patients with a low risk of node metastasis. Alternative surgical approaches, i.e. vaginal surgery, can be taken into account in such patients.

Prognostic importance of the nuclear proteins p53 and Rb in conjunction with DNA, nuclear morphometry and grading in endometrial carcinoma.

In a series of 227 cases of endometrial carcinomas in FIGO stages I-IV, treated during the years 1984-89, immunohistochemical staining for the protein products of the two tumor suppressor genes p53 and retinoblastoma (Rb) were evaluated as prognostic factors with regard to tumor stage, FIGO grade, nuclear grade, morphometric nuclear parameters, DNA ploidy and S-phase fraction. Long-term survival analyses were endpoints and the Cox multivariate technique was used to evaluate the prognostic factors. In 20% of the cases p53 was positive. This was a genuine high-risk group associated with primary advanced carcinoma, nonendometrioid histology, poorly differentiated tumors, severe nuclear atypia, DNA aneuploidy, primary persistent tumors, recurrent tumors and a poor long-term survival rate (37% 5-year survival). In patients dying of their disease, 54% of the tumors stained positive for p53, compared with only 10% of the tumors not killing their hosts. Positive p53 staining was more common in older women. A pathologic Rb status (negative staining) was recorded in 6% of the cases. The Rb factor had only a minor influence on long-term survival and was not significant in multivariate analyses. The p53 staining status was the second most important prognostic factor after the nuclear grade in Cox multivariate analyses, after correcting for stage and age. Immunohistochemical staining for p53 protein should be included among previous available and important prognostic factors in endometrial carcinoma.

Flow-cytometric analysis of nuclear DNA content in endometrial adenocarcinoma. Atypical mitoses are associated with DNA aneuploidy.

Flow-cytometric studies have demonstrated that DNA aneuploidy and proliferative activity are independent prognostic factors in endometrial carcinoma. The authors performed flow-cytometric analysis of the nuclear DNA content of 46 fresh endometrial adenocarcinomas to investigate tumor DNA ploidy and cell-cycle kinetics in relation to histologic features with known prognostic significance, mitotic activity (assessed quantitatively), and clinical features suggestive of hyperestrogenism. Thirty-five tumors (76%) were DNA-diploid, and 11 (24%) were DNA-aneuploid. DNA aneuploidy correlated significantly with two histologic features: high cytologic grade (P < .027) and five or more atypical mitoses per 50 high-power fields (P < .001). The presence of one or more atypical mitosis per 50 high-power fields, evaluated independent of DNA ploidy, was associated with stage III or IV tumors (P < .015). A low proliferative index correlated with tumors with grade 1 architecture (P < .006) and grade 1 or 2 cytology (P < .017); a high proliferative index correlated with vascular invasion by tumor (P < .027). DNA ploidy and proliferative activity did not correlate with any feature indicative of estrogenic status including age, parity, menopausal status, obesity, hypertension, diabetes, exogenous estrogen use, or endometrial hyperplasia. Therefore, in endometrial adenocarcinoma, estrogenic status does not correlate with DNA ploidy or proliferative activity; proliferative activity correlates with tumor grade; and atypical mitoses appear to be highly associated with both DNA aneuploidy and advanced tumor stage, and as such, may identify tumors with a poor prognosis.

Pathological findings and prognosis from uterine malignancy

This review examines methods of assessing the prognosis of uterine tumors published in the past year. Evaluation of mitosis counts has shown that mitotically active leiomyomas without cytologic atypia follow a benign course; furthermore, the mitotic index does not differentiate endometrial hyperplasia from adenocarcinoma. 'Vascular invasion-associated changes' (VIAC) have been identified as a new prognostic factor for stage 1 endometrial adenocarcinoma. HER-2/neu oncogene expression is also a major prognostic factor in endometrial carcinoma, but positive peritoneal cytology influences survival only in the presence of extrauterine disease. Frozen-section diagnosis and curettings findings at the time of surgery identify poor prognostic factors, allowing limited surgery in patients without poor prognostic indicators. Finally, DNA ploidy as determined by flow cytometry was of prognostic value in uterine sarcomas in one study but not in another when endometrial stromal sarcomas were analysed separately.

HER-2/neu Expression: A major prognostic factor in endometrial carcinoma

HER-2/neu Expression: A major prognostic factor in endometrial carcinoma

Obesity as a prognostic factor in endometrial carcinoma

Obesity as a prognostic factor in endometrial carcinoma

DNA content as a prognostic factor in endometrial carcinoma

Two hundred thirty-three cases of endometrial carcinoma were analyzed for DNA content using flow cytometry of cell nuclei extracted from archival paraffin blocks. The median follow-up time for the cases was 8.7 years. Aneuploidy, present in 18% of tumors overall, was associated with adverse histologic type, high grade, and depth of invasion in the uterus. Aneuploidy was not detected in low-grade carcinomas. A DNA index greater than 1.5 strongly predicted death from disease. For endometrial adenocarcinoma and papillary serous carcinoma, this finding appeared independent of stage or tumor grade. The percentage of cells in S phase or G2 + M of the cell cycle did not predict clinical outcome in diploid tumors. Application of DNA analysis to low-stage endometrial cancers of high grade or of papillary serous type may be useful for selecting a subgroup of patients for adjuvant therapy.

DNA ploidy, morphometry, and nuclear grade as prognostic factors in endometrial carcinoma

In a retrospective analysis of 106 cases of endometrial carcinoma stages I-IV (FIGO), the prognostic value of DNA ploidy and nuclear morphometry of tumor cells was evaluated and compared with that of conventional clinical and histopathologic parameters. Paraffin-embedded tumor tissue from the original curettage specimens was used. A flow cytometric technique was employed to distinguish diploid from aneuploid tumors. It was not possible to estimate S-phase rates by this method. Eight different nucleus-related morphometric parameters were computed from representative tumor regions on the original slides. All histologic specimens were reviewed by one pathologist and graded according to FIGO; nuclear grade was determined separately. Tumor stage, depth of myometrial infiltration, and nuclear grade were the most important prognostic factors with regard to tumorrelated survival. DNA ploidy and nuclear morphometry did not add significant prognostic information that could be used to distinguish high-risk and low-risk populations with endometrial carcinomas. The simple nuclear grading system should be further evaluated in prospective studies and compared with DNA analysis and nuclear morphometry performed on fresh-frozen tissue.

Flow cytometric deoxyribonucleic acid index: A prognostic factor in endometrial carcinoma

In a prospective study, flow cytometric deoxyribonucleic acid analyses were performed on cell samples from benign and malignant tumors of the endometrium and benign endometrium. No ploidy aberrations were found in normal endometrium. Of 52 cases with adenocarcinomas, 38 (73%) were diploid and 14 (27%) aneuploid. Both the frequency and the degree of aneuploidy were correlated to histologic tumor grade but not to other prognostic variables such as International Federation of Gynecologists and Obstetricians stage, depth of myometrial invasion, or patient age. Patients with aneuploid tumors had a higher recurrence rate and shorter disease-free intervals as compared to those with diploid tumors. Similarly, death rates were higher and the median survival was shorter in the aneuploid group. Flow cytometric ploidy determination may therefore serve as an important prognostic parameter.