title: Pretreatment proliferation parameters do not add predictive power to clinical factors in cervical cancer treated with definitive radiation therapy.
abstract: OBJECTIVE
  To examine the prognostic value of tumor proliferation measurements in women with carcinoma of the uterine cervix. We report an update of a prospective study focusing on whether pretreatment proliferation parameters are associated with clinical outcome, relative to other established clinical factors.
  
  
  METHODS
  One hundred and one patients were recruited into the study from years 1991 to 1999. The LI for in vivo bromodeoxyuridine incorporation by the tumor and the potential doubling time (T(pot)) were determined by flow cytometry (fc). LI and its staining pattern were also assessed by immunohistochemistry (ih) using tissue sections. Apoptosis was assessed histologically using morphological criteria. Patients were treated with definitive radiation therapy.
  
  
  RESULTS
  A successful fc measurement for LI-fc and T(pot) was possible in 95 patients (94%). The median/mean LI-fc was 6.6/7.6% (range 1.4-36.1%), and for LI-ih, 10.8/11.5%. To date, 43 patients have died of disease, and the median follow-up for alive patients is 6.2 years (range 1.3-9.3 years). Among 88 patients who completely responded to treatment, 40 patients have relapsed (14 pelvic, 23 distant, and 3 pelvic and distant). In univariate analysis, the significant factors for adverse disease-free survival were large tumor size (P = 0.0001), low hemoglobin (P = 0.001), pelvic lymph node status (P = 0.004), stage (P = 0.013), and overall treatment time (P = 0.0008). In multivariate analysis, only tumor size, pelvic lymph node status, and overall treatment time remained significant for disease-free survival. LI-fc, LI-ih, T(pot), ploidy, pattern of bromodeoxyuridine staining, and apoptosis were not significantly associated with clinical outcome in univariate or multivariate analyses.
  
  
  CONCLUSIONS
  These mature data indicate that none of the pretreatment proliferation parameters have prognostic significance in the radical radiotherapy of carcinoma of the uterine cervix, despite the significance of overall treatment time for treatment outcome.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital/Ontario Cancer Institute, University Health Network, Toronto, Ontario, M5G 2M9 Canada. richard.tsang@rmp.uhn.on.ca
authors.forename: Richard W
authors.initials: RW
authors.lastname: Tsang
authors.forename: Stephen
authors.initials: S
authors.lastname: Juvet
authors.forename: Melania
authors.initials: M
authors.lastname: Pintilie
authors.forename: Richard P
authors.initials: RP
authors.lastname: Hill
authors.forename: C Shun
authors.initials: CS
authors.lastname: Wong
authors.forename: Michael
authors.initials: M
authors.lastname: Milosevic
authors.forename: William
authors.initials: W
authors.lastname: Chapman
authors.forename: Wilfred
authors.initials: W
authors.lastname: Levin
authors.forename: Lee A
authors.initials: LA
authors.lastname: Manchul
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Fykes
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D001973:Bromodeoxyuridine; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D002455:Cell Division; D018572:Disease-Free Survival; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007124:Immunoenzyme Techniques; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011838:Radiation-Sensitizing Agents; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy*
chemical_list: D011838:Radiation-Sensitizing Agents; D001973:Bromodeoxyuridine