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Prognostic impact of morphometric nuclear grade of endometrial carcinoma
H B Salvesen1, O E Iversen, L A Akslen
1Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway.
Background:
The identification of high risk patients with endometrial carcinoma is considered essential for individualized therapy to improve prognosis and avoid overtreatment. The goal of the current study was to investigate the prognostic value of nuclear morphometry, particularly for patients with localized endometrial carcinoma.
Methods:
In a prospective study including 115 patients primarily treated for endometrial carcinoma at Haukeland University Hospital in Bergen, Norway between 1981-1990, data regarding clinical variables, histologic type, histologic grade, DNA index, estrogen and progesterone receptor concentration and nuclear morphometry were collected. The median follow-up period for the survivors was 9 years (range, 5-15 years).
Results:
International Federation of Gynecology and Obstetrics (FIGO) stage, histologic type, histologic grade (World Health Organization), DNA index, progesterone receptor concentration, mean nuclear area, greatest and smallest nuclear diameter, nuclear perimeter, and standard deviation to mean nuclear area all influenced survival significantly in univariate analyses. In multivariate analyses, FIGO stage and morphometrically determined mean nuclear size were identified as independent prognostic factors, whereas histologic grade had borderline significance. Histologic type, DNA index, progesterone receptor concentration, and standard deviation of mean nuclear area were not significantly associated with prognosis. The nuclear perimeter was identified as the most powerful prognostic morphometric factor, and in a separate multivariate analysis that included patients with localized disease only, it was also an independent prognostic factor. This also was the case for the subgroup of patients with endometrioid carcinoma, adenoacanthoma, or adenosquamous carcinoma.
Conclusions:
Morphometric nuclear grade was a stronger prognostic factor than subjective histologic grade, histologic type, DNA index, and hormone receptor concentration in endometrial carcinoma patients, including those patients with localized disease.
