DNA level and stereologic estimates of nuclear volume in squamous cell carcinomas of the uterine cervix. A comparative study with analysis of prognostic impact

Abstract

Grading of malignancy in squamous cell carcinomas of the uterine cervix is based on qualitative, morphologic examination and suffers from poor reproducibility. Using modern stereology, unbiased estimates of the three‐dimensional, volume‐weighted mean nuclear volume (nuclear v̄Mv), were obtained in pretreatment biopsies from 51 patients treated for cervical cancer in clinical Stages I through III (mean age of 56 years, follow‐up period >5 years). In addition, conventional, two‐dimensional morphometric estimates of nuclear and mitotic features were obtained. DNA indices (DI) were estimated by flow cytometry. Finally, the semiquantitative malignancy grade score value (MGS) was determined according to previously published methods. Estimates of nuclear v̄Mv were on average increased in euploid lesions (2P = 0.01), but the overall relationship between nuclear v̄Mv and DI was poor. Different clinical stages of disease did not differ with regard to nuclear v̄Mv (2P = 0.99) and DI (2P = 0.56). No relationship was disclosed between MGS and nuclear v̄Mv (2P = 0.85). Single‐factor analysis showed prognostic impact of clinical stage of disease (2P = 0.0001) and DI (2P = 0.04), whereas estimates of nuclear v̄Mv were only of marginal prognostic significance (2P = 0.07). How‐ M ever, Cox multivariate regression analysis showed independent prognostic value of patient age and nuclear v̄Mv along with clinical stage and DI. All other investigated variables were rejected from the model. A prognostic index with highly distinguishing capacity between prognostically poor and favorable cases was constructed (2P = 1.9 × 10−7). It is concluded that realistic estimates of nuclear volume are independent of nuclear DNA content and are of prognostic value for objective malignancy grading in patients with squamous cell carcinoma of the uterine cervix. Copyright © 1992 American Cancer Society