Identification of high-risk groups in endometrial carcinoma stage I-II. A combination of DNA- and steroid receptor-measurements identifies early deaths from the disease.
BACKGROUND
Treatment of endometrial carcinoma has not improved during the last decades, due to the already good results. Such therapy has been a compromise, strong enough to cure some of those in need of harder treatment, but weak enough not to cause too severe side-effects. One way of solving the problem of overtreatment is to identify those in real need of a harder regimen. Generally, the histopathologic picture and the depth of myometrial invasion of the tumour have been used. However, this often means a too large high-risk group, often exceeding 50% of the patients.


METHODS
Steroid receptor concentrations and later DNA-measurements have been increasingly used to identify high-risk groups not, however, in combination. In 156 patients with endometrial carcinoma, both estradiol receptor concentration and flow cytometrically estimated DNA content were measured on all patients and the patients were followed-up for over five years.


RESULTS
By using the number of DNA-populations (ploidy) we could identify a small high-risk group (28%) with a death frequency of 35%. This small group could be further divided, by using the estradiol receptor concentration, into an extremely small high-high-risk group (11%) consisting of 17 patients of whom 9 died from the disease within 5 years, almost all of the deaths occurring within 2 years.


CONCLUSIONS
Thus histopathology was reduced to merely identifying cancer but DNA- and estradiol receptor measurements in combination could identify an extremely small high-risk group, with almost all deaths occurring within 2 years.
Lindahl
B
B
Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden.
Ranstam
J
J
Norgren
A
A
Willén
R
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002454:Cell Differentiation; D016001:Confidence Intervals; D004273:DNA, Neoplasm / Q000032:analysis*; D004171:Diploidy; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011959:Receptors, Estradiol / Q000032:analysis*; D012307:Risk Factors; D013997:Time Factors
D004273:DNA, Neoplasm; D011959:Receptors, Estradiol