MELF生长方式对无特异分子特征子宫内膜样癌预后的预测意义  

Predictive significance of microcystic elongated and fragmented (MELF) growth pattern in the prognosis of no specific molecular profile endometrial endometrioid carcinoma

作　　者：宋子秀 冷慧 赵肖雅 朱林 刘岩[1] 刘从容[1] Song Zixiu;Leng Hui;Zhao Xiaoya;Zhu Lin;Liu Yan;Liu Congrong(Department of Pathology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院病理科,北京100191

出　　处：《中华医学杂志》2025年第10期745-752,共8页National Medical Journal of China

基　　金：国家自然科学基金(82473150);北京大学第三医院临床重点项目(BYSYZD2022015)。

摘　　要：目的探究微囊、拉长及碎片状(MELF)生长方式对无特异分子特征子宫内膜样癌(NSMP‑EEC)预后的关系。方法回顾性纳入2015年1月至2023年9月北京大学第三医院病理科诊断为NSMP‑EEC的911例患者为研究对象,并获取其全子宫切除标本。采用Sanger和二代测序及免疫组织化学技术,依据WHO 2020版女性生殖系统肿瘤分类标准进行分子分型,国际妇产科联盟(FIGO)2023版子宫内膜癌分期进行临床分期。主要观察终点为无进展生存期和疾病特异性生存期。依据是否存在MELF生长方式分为MELF(+)和MELF(-)组,比较两组的临床病理学指标差异。采用Kaplan‑Meier法绘制生存曲线分析MELF生长方式与患者预后的关系,并采用log‑rank检验比较组间差异。结果911例患者的年龄为(54.4±10.7)岁,随访时间[M(Q1,Q3)]为24.0(11.0,41.0)个月。MELF(+)组患者147例(16.1%),MELF(-)组患者764例(83.9%)。MELF(+)组患者绝经占比、G1/G2占比、发生深肌层浸润、淋巴脉管间隙侵犯、淋巴结转移、高FIGO分期、高欧洲妇科肿瘤学会(ESGO)风险分组比例以及肿瘤复发率均高于MELF(-)组(均P<0.05)。MELF(-)和MELF(+)患者的5年累积无进展生存率分别为92.2%和85.8%(P=0.015)。G1/G2 NSMP‑EEC患者中,MELF(-)和MELF(+)患者5年累积无进展生存率分别为94.2%和86.6%(P=0.003)。FIGO 2023版Ⅰ期的NSMP‑EEC患者预后较好,5年累积无进展生存率和累积疾病特异性生存率分别为95.2%和99.1%;MELF(-)和MELF(+)的5年累积无进展生存率和累积疾病特异性生存率差异均无统计学意义(均P>0.05)。结论在NSMP‑EEC患者中,MELF(+)与多种不良临床病理学指标及患者复发风险升高相关,可提供简便快速的风险再分层形态学指标。FIGO 2023版Ⅰ期的NSMP‑EEC患者预后较好,单一使用MELF难以实现风险再分层。Objective To investigate the association between the microcystic,elongated,and fragmented(MELF)growth pattern and the prognosis of no specific molecular profile endometrial endometrioid carcinoma(NSMP‑EEC).Methods A retrospective study was conducted on 911 NSMP‑EEC patients diagnosed at the Pathology Department of Peking University Third Hospital from January 2015 to September 2023. Complete hysterectomy specimens were obtained from these patients. Utilizing sanger sequencing, next generation sequencing and immunohistochemical techniques, we conducted endometrial carcinoma molecular classification according to WHO 2020 criteria, and identified clinical staging based on the International Federation of Gynecology and Obstetrics (FIGO) 2023 criteria. The primary endpoints were progression‑free survival and disease‑specific survival. Patients were divided into MELF (+ ) and MELF (- ) groups based on the presence or absence of the MELF growth pattern, and clinicopathological characteristics were compared between the two groups. Kaplan‑Meier survival curves were used to analyze the association between the MELF growth pattern and prognosis, and log‑rank tests were performed to compare differences between groups. Results The age of the 911 patients was (54.4±10.7) years, with a follow‑up time [M (Q1,Q3)] of 24.0 (11.0, 41.0) months, and of which 147 patients (16.1%) belonged to the MELF (+ ) group. The MELF (+ ) group had a higher proportion of postmenopausal patients and G1/G2, deep myometrial invasion, lymphovascular space invasion, and lymph node metastasis, higher FIGO stages, higher ESGO risk groups, and higher tumor recurrence rates compared to the MELF (-) group (all P<0.05). The cumulative 5‑year progression‑free survival rate for MELF (-) and MELF (+) patients were 92.2% and 85.8%, respectively (P=0.015). In the G1/G2 NSMP‑EEC cohort, the cumulative 5‑year progression‑free survival rate for MELF (-) and MELF (+ ) patients were 94.2% and 86.6%, respectively (P=0.003). The prognosis of NSM

关 键 词：癌 子宫内膜样 无特异分子特征 预后风险分层 国际妇产科联盟2023版分期 

分 类 号：R73[医药卫生—肿瘤]