卵巢浆液性腺癌病理组织学分级及其相关基因突变  

Pathological grading of ovarian serous adenocarcinoma and relevant gene mutations

作　　者：吴春[1,2] 郭庆[1] 余波[1] 章如松[1] 陆珍凤[1] 刘琦[3] 石群立[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院病理科,南京210002 [2]扬州市友好医院病理科 [3]南京大学医学院临床学院南京军区南京总医院妇产科,南京210002

出　　处：《诊断病理学杂志》2013年第12期775-779,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨卵巢浆液性腺癌(OSA)的临床病理学特征和MDACC分级的适用性。方法回顾性分析72例OSA临床病理资料,分别进行MDACC和WHO分级,结合临床参数进行统计学分析。运用直接测序法检测5例卵巢交界性浆液性肿瘤(OBST)、10例低级别OSA和5例高级别OSA中KRAS及BRAF基因。结果 MDACC低级别14例,高级别58例;WHOⅠ级10例,Ⅱ级16例,Ⅲ级46例。MDACC低级别和高级别患者的平均年龄差异显著(P<0.05),WHO分组3组间差异不显著。MDACC分级与OSA复发、pTNM分期、3年存活期显著相关(P<0.05)。WHO分级仅与OSA复发显著相关(P<0.05)。OBST中检测到1例BRAF基因突变;低级别OSA中检测出1例KRAS基因突和1例BRAF基因突变,后者OSA旁OBST区域也检测到BRAF基因突变;5例高级别OSA中未检测到这2种突变。结论 MDACC分级在与临床参数的联系上比WHO分级更紧密,且与OSA分子生物学发病机制具有更高的相关性,在临床运用上有更广阔的前景。Objective To investigate the clinicopathological features of ovarian serous adenocarcinoma（ OSA） and the application of MDACC grading system. Methods Retrospective analysis of the clinical pathological data was conducted in 72 cases of OSA which were classified by WHO grading and MDACC grading,respectively. The relations between histological grading and clinical parameters were statistically analyzed. KRAS and BRAF gene were tested through direct sequencing in 5 cases of ovarian borderline serous tumors（ OBST）,10 cases of low-grade OSA and 5 cases of high-grade OSA. Results By the MDACC system,there were 14 cases of low-grade,and 58 cases of high-grade tumor. WHO system showed gradeⅠin 10 cases,gradeⅡin 16 cases and gradeⅢ in 46 cases. The patients＇ mean age between MDACC low-grade and high-grade groups was of significant difference（ P 0. 05）,but no statistic difference among 3 groups of WHO grading. MDACC grading was significantly related to OSA recurrence,pTNM stage and 3 years survival（ P 0. 05）. WHO grading was only significantly related to OSA recurrence（ P 0. 05）. KRAS gene mutation was found in one low-grade OSA. BRAF mutation was found in one OBST,one low-grade OSA and the OBST area beside the low-grade OSA. No mutation was found in 5 high-grade OSA. Conclusion Compared with WHO grading system,MDACC system is more closely related with clinical parameters and with ovarian serous adenocarcinoma in molecular pathogenesis. It has a broader prospect in clinical application.

关 键 词：卵巢肿瘤 浆液性腺癌 基因突变 

分 类 号：R737.31[医药卫生—肿瘤]