DNA ploidy is stronger than lymph node metastasis as prognostic factor in cervical carcinoma: 10-year results of a prospective study

ABSTRACT: INTRODUCTION. To improve the outcome of cervical cancer patients a more accurate prognostic assessment is essential. The aim of this study was to evaluate the role of tumor DNA-ploidy as independent prognostic factor in cervical carcinoma. Furthermore, we investigated whether the presence of lymph node metastases may have different clinical impact according to ploidy status. METHODS. In a long term prospective study, DNA-ploidy was evaluated by flow cytometry from fresh tumor samples in 136 cervical cancer patients who underwent surgery. Ploidy, lymph node metastases and other classical parameters were analyzed in relation to the length of disease-specific survival. Treatment modalities did not differ between patients with diploid and aneuploid tumors. RESULTS. DNA-aneuploidy was found in 52 patients (38.2%). Patients with DNA-aneuploid tumors had a significantly reduced disease-specific survival (p=0.003). Overall, the 10-year survival probability was 54% for DNA-aneuploid patients, and 80% for patients with DNA-diploid tumors. Among 64 patients with FIGO stage I disease the 10-year survival rates were 38.7% for patients with DNA-aneuploid tumors and 86.3% for DNA-diploid patients (p = 0.003). Overall, diploid tumors with lymph node metastases did significantly better than aneuploid tumors with lymph node metastases (p=0.05). Among patients with FIGO stage I disease, there was a highly significant difference between diploid-node positive patients and aneuploid-node positive patients, with no deaths from disease in the former group in contrast with the worst outcome in the latter group (p=0.005). By multivariate analysis, pathologic tumor stage, lymph vascular invasion and tumor ploidy were significant and independent parameters, whereas lymph node metastases yielded no independent information. CONCLUSIONS. DNA-ploidy was an independent prognostic factor in cervical carcinoma. Presence of lymph node metastases may not have always the same impact on survival, but may vary according to DNA-ploidy of the primary tumor.