子宫内膜癌Ki-67、ER、PR与临床病理特征及预后的关系研究  

Associations of Ki-67,ER and PR with clinicopathological characteristics and prognosis of patients with endometrial carcinoma

作　　者：许嘉木 殷霞[1] 楼微华[1] 施君[1] 祝捷[1] 余敏华[1] 张义[1] 龙潇冉 狄文[1] XU Jiamu;YIN Xia;LOU Weihua;SHI Jun;ZHU Jie;YU Minhua;ZHANG Yi;LONG Xiaoran;DI Wen(Department of Obstetrics and Gynecology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院妇产科,上海200127

出　　处：《上海医学》2024年第6期357-363,共7页Shanghai Medical Journal

基　　金：上海市临床重点专科建设项目-妇产科学。

摘　　要：目的研究子宫内膜癌组织中肿瘤增殖细胞核抗原(Ki-67)、雌激素受体(ER)、孕激素受体(PR)的表达与临床病理特征及预后的关系。方法回顾性分析上海交通大学医学院附属仁济医院于2007—2017年收治的269例子宫内膜癌患者的临床信息、组织病理、免疫组织化学(简称免疫组化)染色结果和随访预后资料,计算患者的总生存时间(overall survival,OS)和无瘤生存时间(progression-free survival,PFS)。并根据患者ER、PR表达情况,将患者分为ER和PR(+)、ER或PR(+),以及ER和PR(-)3组。进行统计学分析免疫组化结果与临床病理特征相关性,采用单因素生存回归分析子宫内膜癌患者各临床特征分组间生存指标OS和PFS的影响因素,将单因素生存回归分析中差异有统计学意义的变量纳入Cox回归模型进行多因素分析。结果269例患者的子宫内膜癌组织的Ki-67、ER和PR阳性率分别为89.2%(240/269)、83.3%(224/269)、78.8%(212/269)。ER(+)或PR(+)或ER和PR(+)是影响纳入患者OS和PFS的相关因素(P值均<0.05)。此外,年龄、病理类型、组织学分级、FIGO 2009分期、原发灶肿瘤最大直径、肌层浸润深度、盆腔淋巴结转移、卵巢转移、宫颈转移也是影响纳入患者OS和PFS的相关因素。多因素生存Cox回归分析显示,手术病理分期和PR表达是PFS的影响因素(P<0.001);而盆腔淋巴结转移(P<0.001)、卵巢转移(P<0.05)和ER表达(P<0.001)是OS的影响因素。与ER和PR(+)、ER或PR(+)患者相比,ER和PR(-)患者的病理组织类型为非子宫内膜样腺癌,组织学分级为2、3级,FIGO 2009分期为Ⅱ~Ⅳ期,肿瘤最大直径≥2 cm,有宫颈转移比例均显著增高(P值均<0.01)。Kaplan-Meier生存分析结果显示,ER和PR(+)患者的OS和PFS分别为(140.64±3.65)和(139.02±3.79)个月,ER或PR(+)患者的OS和PFS分别为(120.69±11.22)和(112.88±11.83)个月,均显著长于ER和PR(-)患者[OS为(113.62±10.30)个月,PFS为(98.00±11.25)个月](P值均<0.001或0Objective To study the association of Ki-67,estrogen receptor(ER)and progesterone receptor(PR)with clinicopathological characteristics and prognosis of patients with endometrial carcinoma.Methods The clinical data,histopathologic status,immunohistochemical results and prognosis data of 269 patients with primary endometrial carcinoma who were admitted to Renji Hospital of Shanghai Jiao Tong University School of Medicine were retrospectively collected.The overall survival(OS)and progression-free survival(PFS)were calculated.The patients were divivided into ER and PR(+)group,ER or PR(+)group,ER and PR(-)group according to the expression of ER and PR.The correlation between immunohistochemical results and clinicopathological characteristics was statistically analyzed.Univariate and multivariate Cox analyses were used to investigate the influencing factors of OS and PFS.Results The positive rates of Ki-67,ER and PR were 89.2%(240/269),83.3%(224/269)and 78.8%(213/269)in these patients,respectively.The expression of ER and PR was influencing factors of OS and PFS of the patients(all P<0.05).Moreover,age,pathological type,histological grading,FIGO 2009 staging,maximum diameter of primary tumor,depth of invasion,lymph node metastasis,ovarian metastasis,and cervical metastasis were also relavant factors affecting OS and PFS of the patients.Multivariate Cox analysis showed that surgical pathological stage and PR expression had significant impact on PFS(P<0.001);pelvic lymph node metastasis(P<0.001),ovarian metastasis(P<0.05),and ER expression(P<0.001)were influencing factors of OS.The proportions of non endometrioid adenocarcinoma,histological grade 2 and 3,FIGO 2009 stageⅡ-Ⅳ,tumor maximum diameter≥2 cm,and the occurrence of cervical metastasis in patients with negative ER and PR were significantly higher than those in patients with positive ER and PR and patients with positive ER or PR(all P<0.01).Kaplan-Meier survival analysis showed that the OS and PFS were(140.64±3.65)months and(139.02±3.79)months in patients wi

关 键 词：子宫内膜癌 免疫组织化学 临床病理特征 预后 

分 类 号：R737.33[医药卫生—肿瘤]