Mean nuclear volume: a supplementary prognostic factor in endometrial cancer

We evaluated the following nine parameters with respect to their prognostic value in females with endometrial cancer: four stereologic parameters [mean nuclear volume (MNV), nuclear volume fraction, nuclear index and mitotic index], the immunohistochemical expression of cancer antigen (CA125) and the postsurgical stage (P-stage), the malignancy grade, the depth of myometrial tumor invasion and the age of the female. Tissue was obtained from 68 consecutive endometrial cancer patients with clinical FIGO stage I tumors who were registered in the Danish endometrial cancer study (DEMCA). The primary operation included total abdominal hysterectomy and bilateral salpingo-oophorectomy. All patients underwent radical operations. The tumors were classified postsurgically as P-stage I-III. All patients received the same postoperative radiation therapy. The surviving patients were observed for a median of 6.4 years (range 5.0-8.4 years). Cox regression analysis (automatic forward selection) showed the MNV to be the most significant prognostic parameter followed by the P-stage. Patients who had localized tumors or tumors with small nuclei had a better probability of surviving than did women with advanced tumors or tumors with large nuclei. No significant relationship between survival and the remaining seven parameters was demonstrated. This first investigation of the prognostic value of the MNV in females with endometrial cancer demonstrates that it may assist the distinction between those patients who can be cured by hysterectomy alone and those who need adjuvant therapy.