Clinical Value of Morphometric and DNA Flow Cytometric Variables as Independent Predictors of Survival in Epithelial Ovarian Carcinoma: A 5-year Follow-up Study

Abstract

The aim of this follow-up study is to validate the clinical significance of quantitative morphometric and DNA flow cytometric variables as independent prognostic factors of overall survival and progression-free survival in epithelial ovarian carcinoma. Tumor samples were collected from 135 patients with epithelial ovarian carcinoma at 3 hospitals in the Netherlands. Evaluated clinico-pathologic variables were age, histologic subtype, differentiation grade, clinical stage [International Federation of Gynecology and Obstetrics (FIGO)], presence of ascites, serum CA-125, and the completeness of debulking surgery. Morphometry and DNA flow cytometric techniques were assessed on each tumor sample to determine the mitotic activity index (MAI), volume percentage epithelium, mean nuclear area (MNA), standard deviation of MNA (SD MNA), nuclear perimeter (NP), and DNA ploidy. Univariate analysis showed that differentiation grade, FIGO stage, presence of ascites, preoperative CA-125 levels, DNA ploidy, and MAI, NP, and MNA were of significant prognostic value. After multivariate analysis (using forward Cox proportional hazard analysis), only differentiation grade and FIGO stage remained significant. From this study, we can conclude that morphometry and DNA flow cytometry are not independent prognosticators and therefore have no clinical value in predicting prognosis in ovarian carcinoma.

DNA Cytometry and Nuclear Morphometry in Ovarian Benign, Borderline and Malignant Tumors

“…Our study showed significant positive correlation between DNA content and nuclear area in all serous and mucinous groups. These results came similar to those of Veerman et al, 2009 [ 19 ] who also showed that DNA ploidy and MNA (Mean Nuclear Area) were of significant prognostic value. Also, Lassus et al, 2011 [ 40 ] stated that DNA aneuploidy is a strong predictor of poor prognosis in serous ovarian carcinoma.…”

“…DNA ploidy and/or S-phase fraction have been used as biologic predictors of aggressive behaviour in a variety of solid tumours [ 17 ]. Recently, attention has focused on borderline lesions to determine if flow cytometry plays a role in separating potentially aggressive tumours from those which will pursue a more innocuous course [ 18 , 19 ].…”

Utility of nuclear morphometry in serous ovarian carcinoma and its correlation with grades

“…In malignant tumors, the nuclear size is usually larger and more irregular in high-grade (HG) tumors as compared to benign lesions and is a reflection of DNA content, ploidy, and active proliferation. Nuclear morphometric study is one of the techniques to evaluate the tumors and their grades [4,5]. Computer-assisted image morphometry provides high-precision measurement of several variables, characterizing the size and shape of nuclei.…”