Prognostic Significance of Flow Cytometric Nuclear DNA Quantification in Ovarian Tumors

Lee, Chong Seung; Kim, Young Tae; Kim, Jae Wook; Park, Ki Hyun; Kim, Sung Hoon

Abstract

OBJECTIVE
The aim of this study was to investigate the relationship of DNA ploidy, SPF to other surgicopathologic factors including stage, grade and CA-125 in ovarian cancer and to evaluate the association between CA-125, DNA ploidy, SPF and 2-year survival in ovarian cancer.
METHODS
The study was prospective, which included 56 patients with ovarian tumors who were treated at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine from Feb. 2000 to Jan. 2003. There were 7 benign tumors, 9 borderline tumors and 40 malignant tumors. All patients underwent surgical operation for fresh tissue. All specimens for histopathologic grading and stage were classified according to WHO criteria and FIGO stage. DNA ploidy groups were divided into two groups, diploidy and aneuploidy. DNA ploidy and S-phase fraction (SPF) were analyzed by flow cytometry in fresh surgicalspecimens from primary ovarian tumor. CA-125 was measured at diagnosis and after 6th courses of chemotherapy.
RESULTS
Of the Benign tumors, 85.7% were diploidy, 14.3% were aneuploidy. Of the borderline tumors, 88.9% were diploidy, 11.1% were aneuploidy, 60.0% of malignant tumors were diploidy, 40.0% were aneuploidy. In relation between grade and DNA quantification, grade was not significantly associated with DNA ploidy (p=0.07), SPF (p=0.08). In the relationship of stage to DNA quantification, aneuploidy was associated with advanced stage (p=0.2), mean value of SPF was significantly high in advanced stage (stage III+IV) (p=0.04). In the DNA ploidy and SPF, mean value of SPF was 5.5 +/- 4.6% in diploidy and 13.6 +/- 12.8% in aneuploidy. The difference was significant (p=0.03). The serum CA-125 level after six courses was divided into two groups with a CA-12535 U/mL, aneuploidy and mean value of SPF were increased significantly in CA-125>35 U/mL (p=0.05, 0.04). In 2-year survival, CA-125>35 U/mL, aneuploidy and SPF>10% were poor prognostic parameters.
CONCLUSION
CA-125 is an important prognostic factor in ovarian cancer. Our results were consistent with the concept that aneuploidy or high percentage of SPF could predict the poor prognosis of disease course. The flow cytometric DNA quantification in ovarian cancer may provide major information about tumor prognosis.