The role of DNA ploidy in postoperative management of stage I endometrial cancer

Definition of high-risk stage I endometrial cancer (EC) patients who might benefit from adjuvant therapy (AT) is controversial. Decision is on the basis of traditional prognostic factors. We report our experience in which ploidy has found to play a role in clinical practice since 1999. Two hundred and twenty-two patients with stage I EC with a median follow-up of 4.57 years were studied. After primary surgery, patients are chronologically divided in group A, from 1990 to 1998 (n = 141), receiving AT in IC stage and group B, from 1999 to 2003 (n = 81), receiving AT in case of DNA index >1.2 or stage IC grade 3 with unknown lymph node status. We analyzed prognostic factors, survival and relapse rate of the two groups. Since ploidy was introduced as a decision-making factor, only 30.6% (n = 11) of patients with stage IC received AT. Despite this considerable decrease of AT, no tumor-related deaths were reported in the group of patients with diploid IC stage who did not receive AT. Only DNA ploidy and age at diagnosis were independent predictors of overall survival. Our results indicate the important role of ploidy in order to identify high-risk patients who need AT and avoid overtreatment.