Prognostic flow cytometric information in cervical squamous cell carcinoma: a multivariate analysis of 307 patients.
In a prospective study of 307 patients with invasive squamous cell carcinoma of the uterine cervix, the prognostic impact of flow cytometric parameters (ploidy level and the fraction of S-phase cells) and clinical variables was evaluated using univariate and multivariate analyses (Cox model). Mean follow-up time as 39 (4-84) months. A total of 93 patients died from their disease during the follow-up. The S-phase fraction was evaluable in 242 cases. By means of univariate models, lethality rate was found to increase significantly with increasing age, postmenopausal status, advancing stage, and increasing S-phase fraction. In a multivariate analysis of the clinical variables of age, stage, and grade, only clinical stage was prognostic. The inclusion of ploidy level in the analysis gave no additive prognostic information. In a multivariate analysis including all variables mentioned above, stage was the strongest predictor of survival. S-phase fraction was significantly related to survival both when studied as a continuous variable (P = 0.006) and when studied as a categorized variable (10, 15, 20% as cutoff points), and in this special analysis ploidy level was of prognostic interest with a poorer survival for near-diploid cases. The outcome was poorer with increasing age. The prognostic impact of the S-phase fraction remained highly significant in separate analyses of the clinically interesting stages Ib-IIb (P less than 0.001). We conclude that measurement of the S-phase fraction is of prognostic interest and may be used for the identification of high-risk patients within a given stage, whereas ploidy level yields little information.
Strang
P
P
Department of Oncology, Uppsala University, Akademiska Sjukhuset, Sweden.
Stendahl
U
U
Bergström
R
R
Frankendal
B
B
Tribukait
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000473:pathology*; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011003:Ploidies; D011379:Prognosis; D011446:Prospective Studies; D016196:S Phase / Q000502:physiology*; D002583:Uterine Cervical Neoplasms / Q000235:genetics / Q000473:pathology*