DEOXYRIBONUCLEIC-ACID ANALYSIS FACILITATES THE PRETREATMENT IDENTIFICATION OF HIGH-RISK ENDOMETRIAL CANCER-PATIENTS

OBJECTIVE: Our purpose was to assess the proficiency with which cytometrically determined deoxyribonucleic acid variables from pretreatment curettage specimens identify patients at high risk for extrauterine disease or posttreatment relapse. STUDY DESIGN: Flow cytometrically determined deoxyribonucleic acid ploidy, S-phase fraction, deoxyribonucleic acid index, and proliferative index were assessed in 140 paraffin-embedded curettage specimens containing endometrial carcinoma. RESULTS: Although clinical staging identified only 19% of patients with advanced disease, 46% of surgical stages III and IV were aneuploid, 69% had an S-phase fraction greater-than-or-equal-to 9%, and 69% had a proliferative index greater-than-or-equal-to 14%. Documented recurrences and cancer-related deaths correlated with nondiploid patterns (29% of 140, 50% of recurrences, 54% of deaths), S-phase fraction greater-than-or-equal-to 9% (41 % of 140, 67% of recurrences, 75% of deaths), and proliferative index greater-than-or-equal-to 14% (45% of 140, 73% of recurrences, 79% Of deaths). Deoxyribonucleic acid index (< 1.5 vs > 1.5) provided additional stratification of aneuploid tumors (p < 0.01). Multivariate analysis identified the proliferative index as the most cogent independent prognostic factor (p < 0.01). CONCLUSION: Deoxyribonucleic acid ploidy and proliferative activity in pretreatment curettage specimens identified the majority of patients at high risk for extrauterine metastasis and relapses.