116例宫颈癌综合治疗的临床观察

目的：探讨宫颈癌综合治疗的合理选择及临床价值。方法：采用综合治疗方案治疗116例宫颈癌，对其治疗结果进行临床对比观察。结果：1）单纯手术组Ⅰb、Ⅱa、Ⅱb期3年生存率分别为87．5％、60，0％、50．0％。手术＋术前放疗组Ⅰb、Ⅱa、Ⅱb期3牟生存率分别为87，5％、85．7％、81．8％。手术＋术后放疗组Ⅰb、Ⅱa、Ⅱb3牟生存率分别为100％、75．0％、75．0％。放疗＋化疗组Ⅲ、Ⅳ期患者的3年生存率分别为52，6％，0。各组生存率有显著性差异（P〈0．01）。2）临床分期和术后盆腔淋巴结转移是影响预后的重要因素．术后盆腔淋巴结无转移者3年生存率为95．7％，盆腔淋巴结转移1～2枚者3年生存率为75．0％，盆腔淋巴结转移〉2枚者3年生存率为563％。结论：宫颈癌综合治疗的近期疗效优于单纯手术，术前放疗能提高手术切除率，并不增加术后并发症．淋巴结转移枚数与宫颈癌的生存率相关，术后有不良预后因素者应加辅助治疗。     

全盆分段加速超分割放射治疗晚期宫颈癌临床研究

目的：探讨分段加速超分割放疗治疗晚期子宫颈癌的临床价值。方法：于1998年6月至2001年2月分别采用全盆分段加速超分割放疗（A组）及全盆常规放疗（B组）治疗60例Ⅱb期以上宫颈鳞癌，对治疗效果和放疗不良反应进行比较。结果：A组全疗程平均39．1天完成，B组平均58天完成，分段加速超分割放疗组疗程显著短于常规放疗组（P〈0．05）；5年生存率及局部控制率A组分别为52．17％（12／23）及69．57％（16／23），B组为39．28％（11／28）及57．14％（16／28），有上升趋势，但无统计学差异（P〉0．05）；各种近期放疗副反应二组无明显差异；远期放疗反应：第一位为照射野皮下纤维化，发生率A、B组分别为65．22％（15／23），75％（21／28）（P〉0．05），其次为阴道闭锁和狭窄二组无差异；放射性直肠炎和放射性膀胱炎均为Ⅰ～Ⅱ度未出现Ⅱ～Ⅲ度毒性反应，二者之间无差异。结论：全盆分段加速超分割治疗晚期宫颈癌有提高晚期宫颈鳞癌生存率及局部控制率的作用，明显缩短总疗程，不增加放疗不良反应。     

分段加速超分割放疗联合化疗治疗晚期宫颈癌的临床研究

目的：探讨分段加速超分割放疗联合化疗治疗晚期子宫颈癌的临床价值。方法：1998年6月～2001年2月分别采用全盆常规放疗（A组）、全盆分段超分割放疗（B组）以及全盆分段超分割放疗同时联合化疗（C组）治疗ⅡB期以上宫颈鳞癌，对放疗不良反应和治疗效果进行临床比较研究。结果：1）A组全疗程平均58d完成，B组39．1d完成，C组40．1d完成，分段超分割放疗组疗程显著短于常规放疗组，P〈O．05；2）5年生存率3组分别为39．28％（11／28）、52．17％（12／23）和62．96％（17／27），局部控制率3组分别为57．14％（16／28）、69．57％（16／23）和77．78％（21／27），均有上升趋势，但差异无统计学意义，P〉0．05；3）A、B和C组转移率分别为32．14％（9／28）、30．43％（7／23）和3．70％（1／27），单纯放疗组明显高于放化疗组，P〈0．05；4）各种近期放疗反应3组差异无统计学意义；远期放疗反应分别为照射野皮下纤维化[发生率3组分别为75．OO％（21／28）、65．22％（15／23）和70．37％（19／27）]、阴道闭锁和狭窄、直肠反应及膀胱反应，差异均无统计学意义，P〉0．05。结论：全盆加速超分割放疗联合化疗治疗晚期宫颈癌有提高晚期宫颈鳞癌生存率及局部控制率的趋势，并能降低远处转移发生率，明显缩短总疗程，不增加放疗不良反应。     

术后放疗对T1-2N1M0期三阴乳腺癌患者预后的影响

目的 分析T1-2N1M0期三阴性乳腺癌（TNBC）患者行改良根治术后放疗与否对生存的影响。方法 回顾性分析2004年1月至2010年9月接受改良根治术后129例T1-2N1M0期TNBC患者的临床资料,其中61例行术后常规放疗（放疗组）,68例未行放疗（未放疗组）。分析两组5年总生存率、5年无局部复发生存率和5年无病生存率以及影响局部复发的因素。结果 中位随访时间为67个月,全组患者中27例（20.9％）出现局部区域复发。放疗组较未放疗组提高了5年无局部复发生存率（88.5％ vs. 70.6％,P=0.017）和5年无病生存率（78.7％ vs.63.2％, P=0.068）。放疗组和未放疗组的5年生存率分别为88.5％和82.4％（P=0.341）。单因素分析显示年龄、T分期、淋巴结阳性数、是否放疗是影响无局部复发生存的预后因素（P＜0.05）。多因素分析显示未放疗（HR=3.432,P=0.010）和淋巴结3枚阳性（HR=2.915,P=0.020）是影响局部区域复发的独立预后因素。结论 术后放疗可明显改善T1-2N1M0期TNBC患者的无局部复发生存。淋巴结3枚阳性者局部控制更差,增加区域淋巴结照射是可行的。     

宫颈鳞癌预后因素的层别化及其临床意义

目的：探讨影响宫颈鳞癌预后的因素，将其按预后风险水平层别化，并建立预后预测系统以指导个体化治疗方案。方法：对287例FIGO Ⅰ bI-Ⅱb期宫颈鳞癌的临床病理资料和随访结果进行分析．通过单因素和多因素分析筛选并层别化预后影响因素。结果：287例患者5年无瘤生存率为81.3％多重COX回归分析显示．影响预后的独立因素为盆腔淋巴结转移（P〈0．001）和宫旁切缘阳性（P=0．013）（A级因素）、宫颈深肌层浸润（P=0．035）（B级因素）、具有A级因素者局部复发率、局部伴远处转移率和远处转移率分别为27．4％、4．1％和13．7％：具有B级因素者局部复发率为20．0％，局部伴远处转移率为1．1％，远处转移率为1．1％：无A级或B级因素者局部复发率为9.2％．局部伴远处转移率为1．7％，远处转移率为0．8％，根据A级和B级因素建立预后预测系统，高危组患者具有A级因素，5年无瘤生存率为25．0％～61.3％；中危组患者无A级因素但具有B级因素．5年无瘤生存率为83．7％；低危组患者无A级或B级因素，5年无瘤生存率为93．9％，结论：盆腔淋巴结转移、宫旁切缘阳性、宫颈深肌层浸润为影响宫颈鳞癌预后的因素。具有上述不同因素的患者预后风险及复发模式有所不同，有必要采取个体化的治疗来提高远期疗效.     

宫颈癌术后盆腔淋巴结转移化放疗的价值

目的：对宫颈癌根治术后有盆腔淋巴结转移的患采用化疗加盆腔放疗,评价其治疗效果。方法：１０３例Ⅰｂ、Ⅱａ期宫颈鳞癌行广泛性子宫切除加双 盆腔淋巴结清扫术,术后病理检查有盆腔淋巴结转移分两组,Ａ组５２例,ＢＶＰ方案化疗加盆腔放疗;Ｂ组５１例,单纯盆腔放疗。结果：五年生存率Ａ、Ｂ两组分别为５７．７％和４９％,盆腔复发和远处转移分别是４６．３％和５２．９％,经统计学处理均无显差异（Ｐ〉０．０５）。临     

IORT在宫颈癌治疗中的应用体会

目的：对术中放射治疗（IORT）在宫颈癌患者中的应用进行初步评价。方法：回顾性分析181例宫颈癌患者应用IORT后的效果。结果：在9例宫颈癌复发患者中，1例IORT后9个月因全身多发转移死亡；1例在IORT后14个月阴道残端复发，余7例IORT后均无瘤生存至今。172例IORT宫颈癌Ⅱb期患者，5年无瘤生存率、5年生存率、5年局部控制率分别为86．5％、89．7％、94．5％；按鳞癌、腺癌、腺鳞癌分类，其5年生存率分别为93．2％、91．7％、56．0％。术后发生与IORT相关的并发症少且经保守治疗后大多可自愈。结论：IORT有很好的肿瘤原发部位的局部控制效果，不仅对宫颈复发癌是一项可供选择的治疗手段，对于Ⅱb期宫颈癌初治患者选择“经腹全子宫双附件切除术＋选择性盆腔淋巴结剥除术＋IORT”也是一项有进步意义的综合治疗方案。     

Ⅰb2Ⅱa期子宫颈癌腔内放疗加手术与单纯手术治疗的临床对比分析

目的：比较术前近距离腔内后装放疗和单纯手术治疗Ⅰb2、Ⅱa期宫颈癌的疗效，以探讨Ⅰb2、Ⅱa期宫颈癌术前适当剂量阴道腔内放疗的意义。方法：选取北京妇产医院1998年6月至2005年6月，Ⅰb2、Ⅱa期且宫颈肿块均〉4cm的宫颈癌患者78例。患者随机分为两组：术前放疗组38例行术前^192Ir近距离腔内放疗，阴道盒源旁1cm 2000～3000cGy，分2～3次，2～3周完成，放疗后10～14天行宫颈癌根治术即广泛子宫切除＋盆腔淋巴结清扫术；单纯手术组40例直接行宫颈癌根治术。评定两组的疗效和术前阴道腔内后装放疗对手术的影响及术后并发症的情况。结果：术前放疗组宫颈肿块均有不同程度的缩小，总有效率（CR＋PR）94．7％（36／38），术前放疗组和单纯手术组相比未增加手术难度和术后并发症，两组局部控制率分别为1年（89．5％和80．0％，P〉0．05）、3年（82．9％和61．3％，P〈0．05）、5年（76．9％和52．6％，P〈0．05）；两组1、3和5年生存率分别为（85．0％和92．1％，P〉0．05）、（83．9％和87．9％，P〉0．05）和（78.3％和80．0％，P〉0．05），差异无显著性。结论：术前近距离阴道腔内后装放疗可作为Ⅰb2、Ⅱa期宫颈癌综合治疗的一种有效的治疗方法，对Ⅰb2、Ⅱa期宫颈癌有满意的局部控制率。     

放化疗同步治疗中晚期宫颈癌疗效观察

目的：探讨放疗同步动脉灌注化疗及静脉化疗治疗中晚期宫颈癌的疗效及毒副反应。方法：将60例Ⅱb期-Ⅲb期宫颈癌患者随机分为2组：同步放疗联合动脉灌注及静脉化疗组（综合组）30例，单纯放疗组（单放组）30例；两组放疗方法相同，综合组于放疗前给予PVB（顺铂、长春新碱、博来霉素）髂内动脉灌注化疗1次及放疗中、后予PVB方案静脉化疗2周期，每周期间隔28天，共化疗3周期。比较两组病例近期、远期疗效及毒副反应。结果：综合组与单放组近期有效率分别为93．3％、70％（P〈0．05）；1年、3年、5年生存率综合组分别为86．7％、80％、73．3％，单纯放疗组分别为76．7％、50％、46．7％，两组1年生存率比较无统计学意义（P〉0．05），3年、5年生存率比较有统计学意义（P〈0．05）。综合组骨髓抑制及消化道反应发生率均高于单纯放疗组（P〈0．05），对症治疗后均可耐受。结论：放疗同步动脉灌注及静脉化疗治疗晚期宫颈癌可提高患者治疗效果。     

体外加腔内照射与单纯外照射治疗宫颈癌的远期疗效观察

 目的分析体外加腔内照射（Ａ组）与单纯外照射（Ｂ组）治疗宫颈癌的远期疗效。方法　外照射加１９２Ｉｒ高剂量率后装腔内放疗治疗宫颈癌４５例，并与同期单纯外照射宫颈癌４５例进行比较。结果　Ⅱ期Ａ组和Ｂ组５年生存率分别为９０％　和６３．６％（Ｐ＜０．０５），局部复发率分别为２０％和５０％（Ｐ＜０．０５）；Ⅲ期Ａ组和Ｂ组５年生存率分别为６８％　和４３．５　％　（Ｐ＜０．０５），局部复发率分别为２８％　和６５．２％（Ｐ＜０．０１）。鳞癌和腺癌的５年生存率分别为６７．９％和３３．３％（Ｐ＜０．０５）。结论宫颈癌的５年生存率及局部控制率体外加腔内放射治疗明显优于单纯外照射，鳞癌优于腺癌。     

Prognostic value of DNA flow cytometry in the locally recurrent, conservatively treated breast cancer patient.

PURPOSE: This study attempted to determine the prognostic value of DNA flow cytometry in the treatment of patients with locally recurrent, conservatively treated breast cancer. METHODS AND MATERIALS: Of 433 patients with clinical stage I and II breast cancer treated with conservative surgery and radiotherapy at Yale-New Haven Hospital before January 1985, 50 patients experienced an ipsilateral breast relapse as a first site of treatment failure. Using standard flow-cytometric techniques, DNA ploidy, DNA index, and S-phase fraction (SPF) were measured for 38 of the 50 (76%) paraffin-embedded specimens available for analysis. RESULTS: At a median postrecurrence follow-up of 5.8 years, the 5-year and disease-free survival rates following ipsilateral breast treatment failure were 48% and 54%, respectively. Sixty-three percent of the recurrent tumors were DNA diploid and 37% were aneuploid. Both DNA ploidy and SPF were statistically significant prognostic indicators for 5-year survival and disease-free survival after local recurrence. The 5-year survival rate of the DNA diploid population was 64%, compared with 15% in the aneuploid population (P < .02). Patients with low SPF (< 12%) experienced an 83% 5-year survival rate, compared with a 24% 5-year survival rate in patients with high SPF (> or = 12%) (P < .03). Ploidy and SPF were combined to define the categories of favorable (diploid, low SPF) and unfavorable (diploid, high SPF or any aneuploid subgroups). Patients in the favorable category experienced an 89% 5-year postrecurrence survival rate and a 100% disease-free survival rate, whereas patients in the unfavorable category had a 24% 5-year survival rate and a 32% disease-free survival rate (P < .01). The flow cytometry as a factor correlated with other clinical parameters previously shown to be of prognostic significance in this patient population. In a multivariate analysis, flow cytometry was a statistically significant and independent prognostic factor for disease-free survival following local recurrence. CONCLUSIONS: DNA ploidy and SPF as measured by currently available flow-cytometric techniques show promise as a tool in determining prognosis for the patient with locally recurrent breast cancer. Implications of these findings with respect to issues of adjuvant systemic therapy at the time of local recurrence are discussed.     

Prognostic significance of DNA ploidy, S-phase fraction, and P-glycoprotein expression in colorectal cancer

BACKGROUND AND OBJECTIVES: Parameters that allow prediction of the disease course in colorectal cancer would aid the development of improved treatment strategies. For this reason, we evaluated the prognostic value of flow cytometric DNA ploidy and S-phase fraction (SPF) and P-glycoprotein (Pgp) expression in this type of tumor. METHODS: The prognostic significance of DNA ploidy, SPF, and Pgp expression on paraffin-embedded sections from 107 patients with colorectal carcinoma was determined. The mean follow-up was 36.6 months (range = 3-72 months). DNA ploidy and SPF were evaluated by flow cytometry and Pgp by immunohistochemistry using monoclonal antibody C219. The Cox regression model was used to adjust for several clinical and pathologic covariates. RESULTS: Of the 107 carcinomas examined, 44 (41.1%) were classified as DNA diploid and 63 (58.9%) as DNA aneuploid. DNA ploidy pattern was significantly related to tumor site (P = 0.010), tumor stage (P = 0.016), and vascular invasion (P = 0.015) but not to other clinicopathologic variables. Patients with DNA diploid tumors showed a better survival rate than did those with aneuploid tumors. After stage IV disease was excluded, patients with diploid tumors also presented a better disease-free and overall survival than did patients with aneuploid tumors. Mean SPF of the whole series was 13.5% (median = 11.3%, range = 1.4%-29.9%). Aneuploid tumors had a higher median SPF than did diploid tumors (17 vs. 6.2; P = 0.0001). SPF was only related significantly with tumor location (P = 0.026). In the multivariate analysis, SPF was a significant independent prognostic factor for overall survival (P = 0.01). When stage IV was excluded, SPF was also an independent prognostic variable for both disease-free (P = 0. 02) and overall (P = 0.01) survival. Of 107 tumors, 61 (57%) were positive for Pgp expression, but no relation was found between this and other clinicopathologic parameters. Pgp expression had no influence on survival. CONCLUSIONS: Our results suggest that flow cytometric DNA ploidy and SPF are significant and independent prognostic factors in patients with colorectal carcinoma, whereas Pgp expression is not.     

Stratification of the biologic aggressiveness of non-small cell lung cancer using DNA flow cytometry and immunohistochemistry for the retinoblastoma protein

DNA ploidy pattern and S-phase fraction (SPF) measured by flow cytometry and expression of the retinoblastoma gene product (pRB) estimated by immunohistochemistry were correlated with outcome in 114 patients who received a curative operation for primary non-small cell lung cancer (NSCLC). One hundred ten tumors yielded an adequate DNA histogram, and all tumors exhibited an assessable immunohistochemical stain. DNA diploidy was detected in 31 tumors and DNA aneuploidy in 79 tumors. The mean SPF was 14.1 +/- 6.4%. Eighty tumors were positively stained, and 34 tumors were negative for pRB. Multivariate analysis clarified that both TNM staging and DNA ploidy were prognostic factors after surgery. In 39 recurrent cases, the SPF value was inversely correlated with disease-free interval. With only supportive care after recurrence, high SPF tumors and pRB-negative tumors progressed rapidly, whereas active treatment yielded an equivalent effect on recurrent tumors regardless of the SPF or pRB expression. DNA ploidy is related to the risk of recurrence, while SPF is related to tumor growth rate and the impact of active treatment on recurrence. The utility of pRB expression was limited. The combination of DNA ploidy and SPF allows practical stratification of the biologic aggressiveness of NSCLC.     

The prognostic significance of tumor ploidy and pathology in adenocarcinoma of the esophagogastric junction

Tumor DNA content has been advocated to be an important prognostic indicator in human malignancies. Paraffin-embedded specimens of 75 resected adenocarcinomas (AC) of the esophagogastric junction were studied by flow cytometric DNA analysis to determine whether tumor ploidy was a significant prognostic variable independent of stage and histologic grade of the tumor. Eighty-one percent of the tumors were aneuploid. More patients with aneuploid tumors had lymph node metastases than patients with diploid tumors (P = 0.007). Patients with aneuploid tumors had poorer 18-month disease-free and overall survival than patients with diploid tumors. Cox regression analysis demonstrated that the most important prognostic variables for predicting overall survival were lymph node status, depth of wall invasion, and tumor differentiation. Tumor ploidy was not an independent prognostic variable in predicting recurrent disease or death from AC of the esophagogastric junction. Tumor DNA content is valuable, however, as a marker for patients at increased risk of lymph node metastases, early recurrence, and poorer survival.     

DNA flow cytometry and prognostic factors in 1331 frozen breast cancer specimens

Breast cancer proliferative capacity as determined by the DNA thymidine labeling index, along with estrogen and progesterone receptor status, is highly predictive for risk of relapse and overall survival. Recently, DNA ploidy and proliferative capacity (S-phase fraction [SPF]) as determined by flow cytometry have also shown significant prognostic value. The authors have developed a technique which allows a 50 to 100 mg aliquot of the same frozen breast tumor specimen routinely employed in steroid receptor assays, to be assayed for both DNA ploidy and SPF by flow cytometry. Of the 1331 tumors examined, DNA histograms were evaluable for ploidy in 89% (1184) of specimens examined; 57% of these were aneuploid. Adapting a trapezoidal model to estimate SPF in both diploid and aneuploid tumors, the authors found 81% (1084) to be evaluable for SPF, with a median SPF of 5.8% for the entire population. The median SPF was significantly lower in diploid tumors (2.6%) than in aneuploid tumors (10.3%, P less than 0.0001). Both aneuploidy and high SPF were strongly associated with absence of steroid receptors. Aneuploid tumors showed more striking differences in the frequency of high S-phase values with respect to receptor status and age or menopausal status, whereas diploid but not aneuploid tumors showed lower SPF in node-negative versus node-positive patients. Because it is particularly important to identify the high-risk minority of node-negative patients, the authors examined the node-negative group separately. High SPF subgroups appeared in each category of receptor status and age or menopausal status within the node-negative group, suggesting that SPF will be an independent prognostic factor. With the DNA flow cytometric methods used here, it is now practical to determine ploidy and SPF for nearly every breast cancer patient. These factors, which show associations with established prognostic factors, such as receptor status can now be fully evaluated for their prognostic significance in broad patient populations.     

Prognostic significance of DNA image cytometry in libyan breast cancer

Background: We evaluated the relation of nuclear DNA content and clinicopathological features and prognosis in primary breast cancer of female Libyan patients with variable stage and grade and different treatment regimes. Patients and Methods: Histological samples from 104 patients of breast carcinoma were retrospectively studied by computerized nuclear DNA cytometry. Isolated nuclei from paraffin sections were stained with Feulgen stain and DNA was measured using a computer-assisted image analysis cytometry system. In each case, 200 nuclei were measured and the DNA histograms, S phase fraction (SPF) and number of cells above 5c and 9c were determined. We applied different approaches in the analysis of DNA to compare the DNA histograms with different clinicopathological features and survival. Results: The mean of DNA ploidy mode for all tumors was 3.43; 82.7% of tumors were aneuploid and 17.3% were diploid. The median SPF was 3.5% for DNA diploid and 13.5% for DNA aneuploid tumors. DNA aneuploid tumors and high SPF were associated with advanced stage, distant metastasis, high histological grade and lymph node involvement. The SPF was also associated with large tumor size and with younger patients (<50 years). In the overall population (median follow-up 51 months), patients with aneuploid DNA histograms and high SPF values had shorter survival times than those with diploid DNA histograms and low SPF values (p = 0.001, p < 0.0001, respectively). Also, short survival was associated with a multiploid DNA histogram and with DNA aneuploid cells ≥5 cells (p < 0.0001, p = 0.001, respectively). In a Cox multivariate analysis, DNA ploidy (p = 0.010), age (p = 0.038) and clinical stage (p = 0.001) were independent predictors of overall survival, and DNA ploidy (p = 0.018) and clinical stage (p = 0.001) also proved to be independent predictors of disease-specific survival. The SPF cutoff point of 11% might be applied to separate patients into good and poor prognosis groups. Conclusions: DNA image cytometry with careful analysis of the histograms may provide valuable prognostic information in Libyan breast cancer, with potential clinical implications in patient management, particularly in predicting the patients at high risk for metastasis and recurrence who should be considered as candidates for combined adjuvant therapy.     

The prognostic value of DNA content analysis in patients with squamous cell lung cancer treated surgically

The aims of the study were to assess the degree of ploidy and determine whether it had any influence on the remission time and survival of surgically treated patients with squamous cell lung cancer. The results were then related to the clinical staging, grading, size and location of the tumor. Tissue samples of squamous cell lung carcinoma (n=80) resected between 1995 and 1996 in the Department of Thoracic Surgery at University of Medical Sciences in Poznan were prepared using the modified Hedley's method. The measurements were made by means of a Cytoron Absolute flow cytometer. Abnormal (aneuploid) DNA was found in 45% of the tumors. In the 2-year observation period significantly more patients with aneuploid tumors died (75%) than those with diploid tumors (43.2%), P<0.05. No significant correlation was found between the ploidy and frequency of metastasis to regional lymph nodes, tumor size, location or grading. Estimation of the DNA content in cancer cells appears to be a significant prognostic factor. Furthermore measurement of the DNA content can be useful after surgery to estimate the risk of recurrence.     

Prognostic importance of DNA ploidy and DNA index in stage I and II endometrioid adenocarcinoma of the endometrium

BackgroundWe evaluated the prognostic importance of DNA ploidy in stage I and II endometrioid adenocarcinoma (EAC) of the endometrium with a focus on DNA index.Patients and methodsHigh-resolution DNA ploidy analysis was carried out in tumor material from 937 consecutive patients with International Federation of Gynecology and Obstetrics (FIGO) stage I and II EAC of the endometrium.ResultsPatients with diploid (N = 728), aneuploid tumor with DNA index ≤1.20 (N = 118), aneuploid tumors with DNA index >1.20 (N = 39) and tetraploid tumor (N = 52) had 5-year recurrence rates 8%, 14%, 20% and 12%, respectively. Patients with aneuploid tumor with DNA index >1.20 had a poorer 5-year progression-free survival (67%) and overall survival (72%) compared with the patients with aneuploid tumor with DNA index ≤1.20 (81% and 89%, respectively). Aneuploid tumors with DNA index ≤1.20 relapsed mainly in the vagina and pelvis, whereas aneuploid tumors with DNA index >1.20 relapsed predominantly outside pelvis.ConclusionsThe recurrence risk for the patients with aneuploid tumor is higher than the patients with diploid tumor in EAC of the endometrium. Based on DNA index with cut-off 1.20, aneuploid tumors can be separated into two subgroups with different recurrence pattern and survival.     

DNA flow cytometric analysis and prognosis of axillary lymph node-negative breast carcinoma.

METHODS. The prognostic significance of flow cytometric analysis in patients with node-negative invasive breast carcinoma was evaluated in a retrospective series of 158 patients with a minimum follow-up study of 9 years. RESULTS. The ploidy status could be assessed in 147 specimens (93%), and the proliferative phase or S-phase fraction (SPF) could be assessed in 136 tumors (86%); 70 tumors (48%) were diploid, 49 tumors (33%) were aneuploid, and 28 tumors (19%) were tetraploid. Ploidy status and SPF were correlated significantly with tumor size, histologic grade, nuclear grade, and mitotic rate. By itself, ploidy was not a statistically significant prognostic factor, although all of the patients with multiploid and hypertetraploid tumors had recurrence of disease. The SPF was related significantly to recurrence of disease (P = 0.04). However, when multivariate analysis of various histopathologic variables was performed, SPF ceased to be a significant prognostic determinant, whereas peritumoral lymphovascular invasion was the most important variable. The combination of tumor size and flow cytometric parameters permitted stratification into three groups with different prognoses at the 9-year follow-up review (P less than 0.001). In the low-risk group (diploid tumors less than or equal to 2 cm in diameter with a low SPF or small tetraploid tumors), the recurrence rate was 12%. In the intermediate-risk group (diploid tumors greater than 2 cm in diameter with a low SPF or aneuploid tumors with a low SPF), the recurrence rate was 21%. In the high-risk group (diploid or aneuploid tumors with a high SPF or large tetraploid tumors), the recurrence rate was 49%. The high-risk group status remained a significant variable in the Cox proportional hazards multivariate analysis model. CONCLUSIONS. These results indicate that flow cytometry in breast carcinoma contributes useful but limited prognostic information and stress the importance of using multiple prognostic factors to improve prognostication and optimize patient management.     

Prognostic significance of ploidy and S-phase fraction in primary intraoral squamous cell carcinoma and their corresponding metastatic lymph nodes

BackgroundDespite improvements in diagnosis and therapy of oral and oro-pharyngeal carcinomas during the past 30 years the 5-year disease-free survival is still poor. Patient’s prognosis is affected by cervical lymph node metastasis rather than primary tumors. The DNA ploidy and S-phase fraction (SPF) are associated with tumor aggressiveness and patient outcome in many solid tumors.PurposeAnalysis of DNA ploidy and SPF in primary oral squamous cell carcinoma (OSCC) and corresponding node metastasis as prognostic markers in relation to conventional prognostic factors and disease-free survival (DFS).MethodsPloidy status and SPF (mean value) of 37 formalin-fixed paraffin embedded (FFPE) primary OSCC tumors and their corresponding lymph node metastasis were assessed by flow cytometry (FCM) and correlated with clinicopathologic prognostic parameters and DFS.ResultsMost of OSCC tumors (86.5%) were Grade II. Among primary OSCC the incidence of aneuploidy was 19%, 51.4% showed high SPF (>10.62%) and 48.6% had low SPF (<10.62%). Border line significance (P = 0.10) was detected between ploidy status and SPF in primary tumors. In lymph node metastases all tumors were diploid, 78.4% of metastatic tumors revealed low SPF and only 21.6% showed high SPF. There was a statistically significant correlation (p = 0.02) between site of tumors and DFS and a highly statistically significant correlation (p = 0.01) between SPF of primary tumors and DFS.ConclusionsHigh SPF of primary OSCC tumors assessed by FCM was significantly associated with decreased disease free survival rates. DNA ploidy showed no relationship to bad prognostic indicators in either primary OSCC or their metastatic tumors.