Læknablaðið - 15.02.1996, Page 32

138
LÆKNABLAÐIÐ 1996; 82
DNA flæðigreining eykur nákvæmni
við mat á horfum sjúklinga með
brjóstakrabbamein
Sunna Guölaugsdóttir121, Helgi Sigurðsson1’, Bjarni A. Agnarsson3’, Jón G. Jónasson31, Sigrún Krist-
jánsdóttir31, Guðjón Baldursson1', Sigurður Björnsson1,4’, Þórarinn Sveinsson11, Valgarður Egilsson31
Guðlaugsdóttir S, Sigurðsson H, Agnarsson BA,
Jónasson JG, Kristjánsdóttir S, Baldursson G,
Björnsson S, Sveinsson Þ, Egilsson V
DNA flow cytometry is a useful prognostic guide in
the trcatment of breast cancer
Læknablaðið 1995; 81: 138—47
It is widely agreed that the presence or absence of
axillary lymph-node involvement (N) is the most
reliable predictor of relapse or survival in breast
cancer, together with tumor size (T) and the pres-
ence or absence of distant metastasis (M). These
prognostic factors are the cornerstones of the TNM
staging system. The aim of the present study was to
ascertain, in all patients diagnosed with invasive
primary breast cancer in Iceland during the years
1981-84 (n=347), whether flow cytometric DNA
analysis of ploidy status and fraction of cells in the
S-phase contribute prognostic information, addi-
tional to that obtained with TNM staging variables.
Paraffin fixed tumor material was available from 340
patients (98%) and DNA ploidy and S-phase frac-
tion was assessed with flow cytometry. DNA ploidy
could be analysed in 98% of tumor samples
(n=334), of which 114 (34%) were diploid and 220
(66%) non-diploid. S-phase fraction could be ana-
lysed in 97% of the tumor samples (n=329), the
median S-phase value was 7.0%, and was higher in
non-diploid than diploid tumors (p<0.0001, 9.3%
vs. 2.7%).
Median duration of patient follow-up was 7.5 years.
The disease-free survival at that point of time was
15% higher in patients with diploid tumors than
non-diploid ones (p=0.004, 69% vs 54%). Similar
survival comparison in relation to S-phase fraction
Frá '’krabbameinslækningadeild Landspítalans, 2,lyfjadeild
Borgarspítalans, 3,Rannsóknastofu Háskólans í meina-
fræði, 4)lyfjadeild Landakotsspítala. Fyrirspurnir og bréfa-
skipti: Helgi Sigurðsson, krabbameinslækningadeild
Landspítalans, 101 Reykjavík.
was 30% when the median S-phase value was used
as cut-off point (p<0.0001, S-phase<7.0% being
74% vs. S-phase >7.0% being 44%).
Multivariate analyses with regard to breast cancer
survival and disease-free survival, which included
both ploidy status and S-phase categories adjusting
for age, tumor size and lymph node involvement,
showed the S-phase value categories to be inde-
pendent prognostic variables (p<0.0001). Patients
with high S-phase tumors had a three-fold higher
risk of recurrence than patients with low S-phase
tumors. Ploidy status was not an independent prog-
nostic variable, if however the S-phase categories
were excluded from analysis, ploidy status was on
the borderline of being an independent variable
(p=0.09). In node-negative patients the S-phase
fraction was the only useful variable in determining
prognosis.
We conclude that the S-phase value is a useful prog-
nostic guide for the clinician and will be used for this
purpose in the treatment of breast cancer in Iceland.
Ágrip
TNM stigun er notuð við mat á horfum sjúk-
linga með brjóstakrabbamein, en hún endur-
speglar útbreiðslu sjúkdómsins við greiningu,
það er æxlisstærð (T), eitlameinvörp (N) og
fjarmeinvörp (M). Tilgangur rannsóknarinnar
var að athuga hvort auka mætti nákvæmni við
mat á horfum sjúklinga með brjóstakrabba-
mein með því að bæta við TNM stigunina upp-
lýsingum uni líffræðilega þætti, það er að segja
DNA innihald æxlisfrumna og hlutfall þeirra í
framleiðslufasa eða S-fasa.
Rannsóknin tekur til allra kvenna sem
greindust með ífarandi brjóstakrabbamein á
Islandi á árunum 1981-84 (n=347). Frá 340
(98%) þeirra voru til formalín hert paraffín
innsteypt vefjasýni, en DNA innihald þeirra og
S-fasi voru metin með flæðigreini (flow cyto-
meter).