Immunohistochemical analysis of p53 protein in uterine sarcomas.

This study was undertaken to evaluate the frequency and prognostic significance of p53 protein accumulation in uterine sarcomas. Immunostaining for p53 protein was performed on formalin-fixed, paraffin-embedded sections from 158 patients with verified uterine sarcomas using monoclonal p53 antibody (DO-1). Antigen retrieval was performed with microwave oven technique. Nuclear p53 protein accumulation was demonstrated in 45% of the cases, more often in carcinosarcomas (73%) than in leiomyosarcomas (38%) and endometrial stromal sarcomas (27%). A significant correlation was found between p53 protein accumulation and malignancy grade (P = 0.003), mitotic count (P = 0.007), and DNA ploidy (P = 0.007), but not to FIGO stage (P = 0.6). The 5-year survival was not influenced by level of p53 protein accumulation. In Cox multivariate analysis, free resection margins at primary surgery (P < 0.0001), tumor diameter (P = 0.002), malignancy grade (P = 0.0004), and age at diagnosis (P = 0.0001) were found to be of independent prognostic significance while p53 protein accumulation had no significance (P = 0.022). Our results indicate that p53 alterations may play an important role in the carcinogenesis of uterine sarcomas, but in our study p53 protein accumulation had no impact on prognosis.

Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality.

A total of 1042 patients diagnosed with uterine sarcoma were reported to The Cancer Registry of Norway from 1956 to 1992. In the present study long-term trends in incidence, survival and mortality were analysed. To evaluate the effect of the introduction of chemotherapy in the treatment of this disease, special attention was paid to the time periods 1971-1975 and 1983-1987. The reporting system is based on pathology reports, clinical records and death certificates. Histological type, diagnostic period, clinical stage and age were included in the study. The analysis of survival was based on 5-year relative survival. Both the incidence and mortality rate of uterine sarcomas in Norway doubled in the time period 1956-1992, mainly due to an increase of carcinosarcomas. The overall annual incidence rate in 1987-1992 was 1.7 per 100000 females in the population per year, accounting for 9.7% of all uterine corpus malignancies. In 1990-1992, 26% of the mortality due to uterine corpus malignancies was caused by sarcoma. No change in 5-year survival was seen after the introduction of chemotherapy in the treatment of the disease (P = 0.35). Stage (P < 0.001) and age (P < 0.001) were both important prognostic factors. Patients with an endometrial stromal sarcoma (P < 0.001) had a more favourable prognosis than those with other histological types.

An evaluation of prognostic factors in uterine carcinosarcoma.

The traditional clinical and histopathological prognostic variables and DNA ploidy were analyzed in 46 patients with histologically verified uterine carcinosarcoma. Twenty-three tumors were of the homologous and 23 of the heterologous type. Evaluable flow cytometric DNA histograms from paraffin-embedded tumor tissue were obtained in 39 patients. The overall 5-year cancer related survival was 31%. All tumors were of high malignancy grade. In univariate analysis of survival, extrauterine spread of tumor (P = 0.007), age (P = 0.008), and tumor diameter (P = 0.04) obtained statistical significance. Tumors with components of serous or clear cell carcinomas had a less favorable prognosis (P = 0.017). There was no difference in survival between patients with homologous and heterologous tumors (P = 0.39). Mitotic count, vessel invasion, and DNA ploidy did not obtain prognostic significance. In Cox multivariate analysis, extrauterine spread of tumor (P = 0.004) and age (P = 0.004) were found to be the most important prognostic factors followed by content of serous or clear cell carcinoma components (P = 0.027).

The prognostic significance of surgery, tumor size, malignancy grade, menopausal status, and DNA ploidy in endometrial stromal sarcoma.

To evaluate the prognostic significance of DNA ploidy in endometrial stromal sarcoma, the traditional clinical and histopathological prognostic variables and DNA ploidy in 48 patients with histologically verified endometrial stromal sarcoma were analyzed. Evaluable flow cytometric DNA histograms from paraffin-embedded tissue from the tumor were obtained in 47 patients. In univariate analysis, malignancy grade (P < 0.001), cellular atypia (P < 0.001), tumor diameter (P = 0.001), and mitotic count (P = 0.002) were highly significant. Also menopausal status (P = 0.011), FIGO stage (P = 0.035), and free resection margins at primary surgery (P = 0.026) obtained significance, while vessel invasion and age did not. DNA ploidy was not significant. In Cox multivariate analysis, free resection margins at primary surgery were found to be the most important prognostic factor (P < 0.001), followed by malignancy grade (P = 0.002), tumor diameter (P = 0.019), and menopausal status (P = 0.019). DNA ploidy did not obtain significance. Free resection margins at primary surgery, malignancy grade, tumor diameter, and menopausal status are important prognostic factors in endometrial stromal sarcoma.

The prognostic significance of stage, tumor size, cellular atypia and DNA ploidy in uterine leiomyosarcoma.

To analyze the significance of DNA ploidy in uterine leiomyosarcoma, the traditional clinical and histopathological prognostic variables and DNA ploidy were studied in 70 patients with histologically verified uterine leiomyosarcoma. Evaluable flow cytometric DNA histograms from paraffin-embedded tissue from the tumor were obtained in 58 patients. In univariate analysis tumor diameter, FIGO stage and presence of residual disease after primary surgery were highly significant (p < 0.001) and also DNA ploidy (p = 0.043), age (p = 0.017), and menopause status (p = 0.028) obtained significance. Cellular atypia was almost significant (p = 0.056), while mitotic count, malignancy grade and vessel invasion were not. In Cox's multivariate analysis, FIGO-stage was found to be the most important prognostic factor (p < 0.001), followed by cellular atypia (p = 0.007) and tumor diameter (p = 0.016). DNA ploidy did not obtain significance when categorized as diploid/non-diploid. Patients with tumors with multiple aneuploid cell populations had a very poor prognosis. When categorized as multiple aneuploidy versus all other ploidy groups, DNA ploidy obtained marginal significance in multivariate analysis (p = 0.054). Tumor diameter, stage and cellular atypia are important prognostic parameters in uterine leiomyosarcomas.