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Annals of Oncology Advance Access originally published online on March 19, 2008
Annals of Oncology 2008 19(7):1278-1283; doi:10.1093/annonc/mdn041
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

gynecologic tumors

The role of DNA ploidy in postoperative management of stage I endometrial cancer

G. Mangili1, S. Montoli1,*, P. De Marzi1, I. Sassi2, G. Aletti1, G. Aletti3 and G. Taccagni2

1 Division of Gynecology and Obstetrics
2 Department of Surgical Pathology, IRCCS San Raffaele Hospital
3 Department of Mathematics, University of Milan, Milan, Italy

* Correspondence to: Dr S. Montoli, Division of Gynecology and Obstetrics, Università "Vita e Salute", San Raffaele Hospital, Via Olgettina 60, 20132 Milano, Italy. Tel: +39-02-26432652; Fax: +39-02-26432759; E-mail: montoli.serena{at}hsr.it

Background: Definition of high-risk stage I endometrial cancer (EC) patients who might benefit from adjuvant therapy (AT) is controversial. Decision is on the basis of traditional prognostic factors. We report our experience in which ploidy has found to play a role in clinical practice since 1999.

Patients and methods: Two hundred and twenty-two patients with stage I EC with a median follow-up of 4.57 years were studied. After primary surgery, patients are chronologically divided in group A, from 1990 to 1998 (n = 141), receiving AT in IC stage and group B, from 1999 to 2003 (n = 81), receiving AT in case of DNA index >1.2 or stage IC grade 3 with unknown lymph node status. We analyzed prognostic factors, survival and relapse rate of the two groups.

Results: Since ploidy was introduced as a decision-making factor, only 30.6% (n = 11) of patients with stage IC received AT. Despite this considerable decrease of AT, no tumor-related deaths were reported in the group of patients with diploid IC stage who did not receive AT. Only DNA ploidy and age at diagnosis were independent predictors of overall survival.

Conclusions: Our results indicate the important role of ploidy in order to identify high-risk patients who need AT and avoid overtreatment.

Key words: adjuvant treatment, endometrial cancer, ploidy, prognostic factors

Received for publication May 25, 2007. Revision received December 20, 2007. Accepted for publication January 28, 2008.


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