{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:50:29Z","timestamp":1781502629852,"version":"3.54.1"},"reference-count":31,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"22","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2003,11,15]]},"abstract":"<jats:p> Purpose: To validate the prognostic value of the endometrial carcinoma prognostic index (ECPI; combined myometrium invasion, flow cytometric DNA ploidy, and morphometric mean shortest nuclear axis [MSNA]) versus classic prognosticators. <\/jats:p><jats:p> Patients and Methods: Prospective multicenter ECPI analysis was conducted in 463 endometrial carcinomas with a median of 6.5 years (range, 1 to 10 years) follow-up, review of pathology features, and univariate (Kaplan-Meier) and multivariate (Cox) analyses. <\/jats:p><jats:p> Results: Initial routine and review diagnoses varied considerably (invasion depth, 11%; type, 20%; grade, 34%; vessel invasion, 72%); the review diagnoses were stronger prognostically. In International Federation of Gynecology and Obstetrics stage 1 (after histopathologic examination; pFIGO-1; n = 372; 38 deaths occurred as a result of disease [10.2%]), DNA ploidy was prognostic in hysterectomies (P &lt; .00001) but not in curettages (P = .06). ECPI was a stronger prognostic indicator than other features. ECPI, MSNA, and DNA ploidy were also prognostic in pFIGO-1B and -1C subgroups. Multivariate analysis in pFIGO-1 showed that uterine MSNA \u2264 versus &gt; 7.93 \u03bcm (hazard ratio [HR], 3.4) and grade (as 1 + 2 v 3; HR, 2.6) added to the ECPI (HR, 32), but only in patients with an unfavorable ECPI of &gt; 0.87. Adjuvant radiotherapy was not an independent prognostic factor in any of the subgroups. In pFIGO-2 (n = 46), ECPI, DNA-ploidy, and age (\u2264 64, &gt; 64 years) were significant. In FIGO-3 (n = 31) and FIGO-4 (n = 14), none of the classic or other features analyzed was of prognostic value, which explains why in previous studies using different mixtures of FIGO stages, DNA ploidy prognostic results varied. <\/jats:p><jats:p> Conclusion: In endometrial carcinoma, DNA-ploidy is prognostic in hysterectomy and not in curettage samples. The ECPI is prognostically much stronger than the classic features widely used for therapy triage in pFIGO-1 and -2. <\/jats:p>","DOI":"10.1200\/jco.2003.02.087","type":"journal-article","created":{"date-parts":[[2003,11,14]],"date-time":"2003-11-14T00:12:54Z","timestamp":1068768774000},"page":"4214-4221","source":"Crossref","is-referenced-by-count":32,"title":["Prospective Multicenter Validation Confirms the Prognostic Superiority of the Endometrial Carcinoma Prognostic Index in International Federation of Gynecology and Obstetrics Stage 1 and 2 Endometrial Carcinoma"],"prefix":"10.1200","volume":"21","author":[{"given":"Jan P.A.","family":"Baak","sequence":"first","affiliation":[{"name":"From the Department of Pathology, Rogaland Central Hospital, Stavanger, Norway; Vrije Universiteit; Vrije Universiteit Medical Center; Comprehensive Cancer Center Amsterdam, Amsterdam; and Department of Gynecology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Snijders","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, Rogaland Central Hospital, Stavanger, Norway; Vrije Universiteit; Vrije Universiteit Medical Center; Comprehensive Cancer Center Amsterdam, Amsterdam; and Department of Gynecology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"van Diermen","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, Rogaland Central Hospital, Stavanger, Norway; Vrije Universiteit; Vrije Universiteit Medical Center; Comprehensive Cancer Center Amsterdam, Amsterdam; and Department of Gynecology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"van Diest","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, Rogaland Central Hospital, Stavanger, Norway; Vrije Universiteit; Vrije Universiteit Medical Center; Comprehensive Cancer Center Amsterdam, Amsterdam; and Department of Gynecology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred W.","family":"Diepenhorst","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, Rogaland Central Hospital, Stavanger, Norway; Vrije Universiteit; Vrije Universiteit Medical Center; Comprehensive Cancer Center Amsterdam, Amsterdam; and Department of Gynecology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jantine","family":"Benraadt","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, Rogaland Central Hospital, Stavanger, Norway; Vrije Universiteit; Vrije Universiteit Medical Center; Comprehensive Cancer Center Amsterdam, Amsterdam; and Department of Gynecology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19890401)63:7<1378::AID-CNCR2820630724>3.0.CO;2-Q"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/0090-8258(89)90027-9"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1097\/00004347-199401000-00004"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19970815)80:4<741::AID-CNCR13>3.0.CO;2-T"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1438.2000.00019.x"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.51.1.25"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3880531"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.2820710411"},{"key":"R9","unstructured":"Salvesen HB, Das S, Akslen LA: Loss of nuclear p16 protein expression is not associated with promoter methylation but defines a subgroup of aggressive endometrial carcinomas with poor prognosis. 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