子宫内膜癌中MMR、p53、ER和PR表达与病理特征的关系及预后分析  

Relationship between expressions of MMR,p53,ER and PR and pathological features of endometrial carcinoma and prognostic analysis

作　　者：张喆琳 廖予妹[1] Zhang Zhelin;Liao Yumei(Department of Obstetrics and Gynecology,the Second Affi liated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院妇产科,河南郑州450014

出　　处：《实用肿瘤杂志》2023年第6期543-549,共7页Journal of Practical Oncology

基　　金：河南省科技攻关计划项目(182102310131)。

摘　　要：目的探讨DNA错配修复(mismatch repair,MMR)、p53、雌激素受体(estrogen receptor,ER)和孕激素受体(progesterone receptor,PR)蛋白的表达与子宫内膜癌病理特征及预后的关系。方法回顾性收集2017年1月至2020年12月就诊于郑州大学第二附属医院的178例子宫内膜癌患者的临床资料及MMR[包括mutL同源蛋白1(mutL homolog 1,MLH1)、mutS同源蛋白2(mutS homolog 2,MSH2)、MSH6和减数分裂后分离蛋白2(postmeiotic segregation increased 2,PMS2)]、p53、ER和PR的免疫组织化学(immunohistochemistry,IHC)结果。根据IHC结果,将患者分为错配修复蛋白缺失(deficient mismatch repair,dMMR)组、p53突变组、ER和PR阳性组以及ER或PR阴性组。对所有患者复发情况进行随访。比较各组病理特征及预后的差异。采用Kaplan-Meier法绘制无瘤生存(disease-free survival,DFS)曲线。单因素分析采用log-rank检验。多因素分析采用Cox比例风险模型。结果四组在绝经状态、是否合并子宫肌瘤或腺肌症、病理类型、肿瘤直径、盆腹腔淋巴结转移情况、腹腔冲洗液、组织学分化程度及国际妇产科联合会(Federation International of Gynecology and Obstetrics,FIGO)分期方面比较,差异均具有统计学意义(均P<0.05)。dMMR组、p53突变组、ER和PR阳性组和ER或PR阴性组5年DFS率分别为94.1%、56.1%、92.6%和78.3%,差异具有统计学意义(P<0.05)。单因素分析显示,子宫内膜癌患者DFS在病理类型、肌层浸润深度、脉管癌栓、盆腹腔淋巴结转移、组织学分化程度和FIGO分期方面比较,差异均具有统计学意义(均P<0.05)。多因素Cox比例风险模型发现,组织学分化程度及FIGO分期均是子宫内膜癌患者DFS的独立危险因素(均P<0.05)。结论MMR、p53、ER和PR的IHC结果可用于观测子宫内膜癌患者的复发情况,对评估子宫内膜癌病理特征及观察预后有一定指导意义。Objective To investigate the relationship between the expressions of DNA mismatch repair(MMR),p53,estrogen receptor(ER),and progesterone receptor(PR)proteins and the pathological characteristics of endometrial carcinoma and analyze the prognosis.Methods The clinical data of 178 endometrial carcinoma patients at the Second Affiliated Hospital of Zhengzhou University from January 2017 to December 2020 were retrospectively collected.The immunohistochemistry(IHC)results of MMR[mutL homolog 1(MLH1),mutS homolog 2(MSH2),MSH6 and postmeiotic segregation increased 2(PMS2)],p53,ER,and PR were collected.Based on the IHC results,the patients were divided into deficient mismatch repair(dMMR)group,p53 mutation group,ER and PR positive group and ER or PR negative group.All patients were followed up for recurrence.The differences in pathological characteristics and prognosis were compared among the different groups.Disease-free survival(DFS)curves were drawn by Kaplan-Meier.Log-rank test was used for univariate analysis,and Cox proportional hazards model was used for multivariate analysis.Results The four groups were significantly different in menopause status,condition of uterine fibroids and adenomyosis,pathological type,tumor diameter,pelvic and abdominal lymph node metastasis,peritoneal washing fluid,histological differentiation,and Federation International of Gynecology and Obstetrics(FIGO)stage(all P<0.05).The 5-year DFS rates of the dMMR group,p53 mutation group,ER and PR positive group and ER or PR negative group were 94.1%、56.1%、92.6%and 78.3%,respectively(P<0.05).Univariate analysis showed that DFS was significantly different in terms of pathological type,the depth of myometrial invasion,vascular tumor thrombus,pelvic and abdominal lymph node metastasis,histological differentiation and FIGO stage(P<0.05).Cox proportional hazards model showed that histological differentiation and FIGO stage are both independent risk factors for the DFS of endometrial carcinoma patients(both P<0.05).Conclusions The IHC results of MM

关 键 词：子宫内膜癌 DNA错配修复蛋白 P53 雌激素受体 孕激素受体 无瘤生存期 

分 类 号：R737.33[医药卫生—肿瘤]