A high ratio of apoptosis to proliferation correlates with improved survival after radiotherapy for cervical adenocarcinoma.
OBJECTIVE
A retrospective study was made of the role of apoptosis in determining radiotherapy outcome in 39 adenocarcinoma of the cervix. A comparison was also made of the detection of apoptosis by morphology and the TdT dUtp nick end-labeling (TUNEL) assay.


METHODS
The level of apoptosis was assessed in paraffin-embedded sections by cell morphology, the TUNEL assay, and a combination of the two. A total of 2,000 cells were counted per section, to obtain apoptotic (AI) and mitotic (MI) indices.


RESULTS
Patients with a high AI had a higher survival rate than those with a low AI, however, the difference was not significant. Using a ratio of apoptosis to proliferation indices, patients with an AI:MI > median had significantly better survival than those with AI:MI < median. This was true where the AI was quantified by morphology alone (p = 0.030) or in combination with the TUNEL assay (p = 0.008). Where the AI was quantified by a combination of morphology and TUNEL, the 5-year survival rates for women with AI:MI greater or less than the median were 81% and 25%, respectively.


CONCLUSIONS
A high ratio of AI:MI in adenocarcinoma of the cervix indicates a good prognosis. A combination of the TUNEL assay and morphology provided the best discrimination between outcome groups.
Sheridan
M T
MT
CRC Section of Genome Damage and Repair, Paterson Institute for Cancer Research, Christie Hospital, Manchester, United Kingdom.
Cooper
R A
RA
West
C M
CM
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D002455:Cell Division; D005260:Female; D006801:Humans; D020287:In Situ Nick-End Labeling / Q000379:methods*; D008875:Middle Aged; D008940:Mitotic Index; D011379:Prognosis; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*