子宫内膜癌的临床病理分子亚型分析及文献复习  

Molecular classification of endometrial carcinoma:a clinicopathological analysis and review of literature

作　　者：郑晓丹[1] 黄受方[1] 岳冰[1] 毕傲 徐瑞[1] 左春霞 陈光勇[1] ZHENG Xiao-dan;HUANG Shou-fang;YUE Bing;BI Ao;XU Rui;ZUO Chun-xia;CHEN Guang-yong(Department of Pathology,Beijing Friendship Hospital Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院病理科,北京100050

出　　处：《诊断病理学杂志》2021年第5期337-343,共7页Chinese Journal of Diagnostic Pathology

摘　　要：目的明确子宫内膜癌分子分型的标准诊断流程,探讨4种分子亚型的临床病理特征。方法收集2020-05—2020-11我科确诊的50例子宫内膜癌病例,利用免疫组化染色和Sanger测序,明确分子亚型,并分析各分子亚型的临床病理特点,结合文献复习,讨论预后及治疗方案的选择。结果50例子宫内膜癌中,49例为子宫内膜样癌,其4种分子亚型所占比例分别为POLE突变亚型8.16%(4/49)、MMR-d亚型24.49%(12/49)、NSMP亚型57.14%(28/49)、p53突变亚型10.20%(5/49);1例为浆液性癌,为p53突变亚型。64%(32/50)的患者有肥胖和/或三高表现。比较各亚型存在的病理危险因素,从高到低分别为p53突变、NSMP、MMR-d及POLE突变亚型。50例患者均获得随访资料,其中48例接受根治手术治疗,16例行术后辅助治疗,其中8例化疗的患者均存在脉管侵犯。结论子宫内膜癌4种分子亚型的构成比、临床病理特征与文献报道基本一致。与传统的组织学分类相比,分子分型更加客观、重复性强,能够给临床提供更准确的预后信息,并可能影响辅助治疗方案的选择。Objective To clear the standard diagnostic procedure for molecular classification of endometrial cancer,and to explore the clinicalpathological features of the four molecular subtypes.Methods Fifty cases of endometrial cancer diagnosed in our department from May to November 2020 were collected for analysis,using immunohistochemical staining and Sanger sequencing to clarify molecular classification,analyzing the clinicopathological characteristics,and discussing the prognosis and treatment options of each molecular subtype in combination with literature review.Results Among the50 cases of endometrial cancer,49 cases were endometrioid carcinomas,and the proportions were distributed as follows:8.16%(4/49)POLE mut,24.49%(12/12)MMR-d,57.14%(28/49)NSMP,and 10.20%(5/49)p53 abn.One case was serous carcinoma,the molecular subtype was p53 abn subtype.64%(32/50)of patients had obesity and/or metabolic disorders.The risk factors of each subtype were compared from high to low,respectively p53 abn,NSMP,MMRd and POLE mut.Follow-up data were obtained for all 50 patients,48 cases received radical surgery,16 cases received postoperative adjuvant treatment,and 8 patients with vascular invasion all received chemotherapy.Conclusions The composition ratio and clinicopathological characteristics of the four molecular subtypes of endometrial cancer are basically consistent with those reported in the literature.Compared with traditional histological classification,molecular classification is more objective and reproducible,can provide more accurate clinical information and affect the choice of adjuvant treatment options.

关 键 词：子宫内膜癌 分子分型 检测流程 预后 辅助治疗 

分 类 号：R737.33[医药卫生—肿瘤]