DNA Index Reflects the Biological Behavior of Ovarian Carcinoma Stage I–IIa

The prognostic significance of histologic grade, morphometric analysis, and DNA flow cytometry was evaluated in 64 patients with well-differentiated (group A) and 30 patients with moderately and poorly differentiated (group B) early-stage (FIGO stages Ia, Ib, Ic, and IIa) epithelial ovarian cancer. The extent of the well-defined staging procedure was assessed strictly in every patient. Of 94 patients, 13 had recurrent ovarian cancer (5 from group A and 8 from group B) and 12 of these patients died. A significant difference was found between groups A and B for 5-year disease-free survival (91% versus 75%), the menopausal status, surgical staging procedure, volume percentage epithelium (VPE), morphometric category, DNA ploidy, and DNA index, but not for histologic cell type. For the 94 patients from groups A and B together, a significant difference was observed between diploid and aneuploid tumors with regard to mean mitotic activity index (MAI), mean VPE, and the morphometric categories that combined MAI and VPE characteristics. Prognostic reliability for the occurrence of tumor relapse was highest for DNA index class, followed by tumor grade and DNA ploidy pattern. With multivariate analysis the primary prognostic factor for disease-free survival appeared to be the DNA index. DNA index class was the only parameter that added prognostic information when histologic grade was selected as the primary prognostic factor. If the DNA index was taken as primary prognostic factor, none of the tested parameters including tumor grade added useful information. It was concluded that the DNA index is a primary prognostic factor for disease-free survival in early-stage ovarian cancer patients. Morphometric measurements do not add supplementary prognostic information.