title: DNA ploidy in curettage specimens identifies high-risk patients and lymph node metastasis in endometrial cancer.
abstract: BACKGROUND
  Preoperative risk stratification is essential in tailoring endometrial cancer treatment, and biomarkers predicting lymph node metastasis and aggressive disease are aspired in clinical practice. DNA ploidy assessment in hysterectomy specimens is a well-established prognostic marker. DNA ploidy assessment in preoperative curettage specimens is less studied, and in particular in relation to the occurrence of lymph node metastasis.
  
  
  METHODS
  Curettage image cytometry DNA ploidy in relation to established clinicopathological variables and outcome was investigated in 785 endometrial carcinoma patients prospectively included in the MoMaTEC multicentre trial.
  
  
  RESULTS
  Diploid curettage status was found in 72.0%, whereas 28.0% were non-diploid. Non-diploid status significantly correlated with traditional aggressive postoperative clinicopathological features, and was an independent predictor of lymph node metastasis among FIGO stage I-III patients in multivariate analysis (OR 1.94, P=0.033). Non-diploid status was related to shorter disease-specific survival (5-year DSS of 74.4% vs 88.8% for diploid curettage, P<0.001). When stratifying by FIGO stage and lymph node status, the prognostic effect remained. However, in multivariate regression analysis, preoperative histological risk classification was a stronger predictor of DSS than DNA ploidy.
  
  
  CONCLUSIONS
  Non-diploid curettage is significantly associated with aggressive clinicopathological phenotype, lymph node metastasis, and poor survival in endometrial cancer. The prognostic effect was also observed among subgroups with (presumably) less aggressive traits, such as low FIGO stage and negative lymph node status. Our results indicate curettage DNA ploidy as a possible supplement to existing parameters used to tailor surgical treatment.
authors.affiliation: 1] Department of Clinical Science, University of Bergen, Haukeland University Hospital, 5021 Bergen, Norway [2] Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway.
authors.forename: T S
authors.initials: TS
authors.lastname: Njølstad
authors.affiliation: 1] Department of Clinical Science, University of Bergen, Haukeland University Hospital, 5021 Bergen, Norway [2] Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Trovik
authors.affiliation: 1] Institute for Cancer Genetics and Informatics, Oslo University Hospital, 0424 Oslo, Norway [2] Centre for Cancer Biomedicine, University of Oslo, 0424 Oslo, Norway [3] Department of Informatics, University of Oslo, 0310 Oslo, Norway.
authors.forename: T S
authors.initials: TS
authors.lastname: Hveem
authors.affiliation: 1] Institute for Cancer Genetics and Informatics, Oslo University Hospital, 0424 Oslo, Norway [2] Centre for Cancer Biomedicine, University of Oslo, 0424 Oslo, Norway.
authors.forename: M L
authors.initials: ML
authors.lastname: Kjæreng
authors.affiliation: 1] Institute for Cancer Genetics and Informatics, Oslo University Hospital, 0424 Oslo, Norway [2] Centre for Cancer Biomedicine, University of Oslo, 0424 Oslo, Norway.
authors.forename: W
authors.initials: W
authors.lastname: Kildal
authors.affiliation: 1] Institute for Cancer Genetics and Informatics, Oslo University Hospital, 0424 Oslo, Norway [2] Centre for Cancer Biomedicine, University of Oslo, 0424 Oslo, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Pradhan
authors.affiliation: 1] Department of Gynecology, Sahlgrenska Academy, University of Gothenburg, S-413 45 Gothenburg, Sweden [2] Department of Obstetrics and Gynecology, Halland's Hospital Varberg, 43237 Varberg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Marcickiewicz
authors.affiliation: Department of Gynecology, St Olav's Hospital, 7006 Trondheim, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Tingulstad
authors.affiliation: Department of Gynecology, Oslo University Hospital, Ulleval, 0424 Oslo, Norway.
authors.forename: A C
authors.initials: AC
authors.lastname: Staff
authors.affiliation: Department of Pathology, The Gade Institute, Haukeland University Hospital, 5021 Bergen, Norway.
authors.forename: H K
authors.initials: HK
authors.lastname: Haugland
authors.affiliation: 1] Department of Obstetrics and Gynecology, Akershus University Hospital, 1478 Lørenskog, Norway [2] University of Oslo, Oslo, Norway.
authors.forename: R
authors.initials: R
authors.lastname: Eraker
authors.affiliation: Department of Obstetrics and Gynecology, Haugesund Hospital, 5528 Haugesund, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Oddenes
authors.affiliation: Department of Obstetrics and Gynecology, Hospital of Vestfold, 3116 Tønsberg, Norway.
authors.forename: J A
authors.initials: JA
authors.lastname: Rokne
authors.affiliation: Department of Obstetrics and Gynecology, Førde Hospital, 6800 Førde, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Tjugum
authors.affiliation: Department of Obstetrics and Gynecology, Ålesund Hospital, 6017 Ålesund, Norway.
authors.forename: M S
authors.initials: MS
authors.lastname: Lode
authors.affiliation: Department of Gynecologic Oncology, UZGasthuisberg, KULeuven, 3000 Leuven, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Amant
authors.affiliation: 1] Department of Clinical Science, University of Bergen, Haukeland University Hospital, 5021 Bergen, Norway [2] Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway.
authors.forename: H M
authors.initials: HM
authors.lastname: Werner
authors.affiliation: 1] Department of Clinical Science, University of Bergen, Haukeland University Hospital, 5021 Bergen, Norway [2] Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway.
authors.forename: H B
authors.initials: HB
authors.lastname: Salvesen
authors.affiliation: 1] Institute for Cancer Genetics and Informatics, Oslo University Hospital, 0424 Oslo, Norway [2] Centre for Cancer Biomedicine, University of Oslo, 0424 Oslo, Norway [3] Department of Informatics, University of Oslo, 0310 Oslo, Norway [4] Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK.
authors.forename: H E
authors.initials: HE
authors.lastname: Danielsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003475:Curettage / Q000379:methods; D004273:DNA, Neoplasm / Q000235:genetics*; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000235:genetics* / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011003:Ploidies; D011379:Prognosis; D012307:Risk Factors
chemical_list: D004273:DNA, Neoplasm