A significance of immunohistochemical determination of steroid receptors, cell proliferation factor Ki-67 and protein p53 in endometrial carcinoma.
A significance of immunohistochemical determination of steroid receptors, cell proliferation factor Ki-67 and protein p53 in endometrial carcinoma.
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DOI：
10.1016/j.ygyno.2003.12.038
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发表时间：
2004-04
影响因子：
4.7
通讯作者：
S. Orešković;D. Babić;D. Kalafatić;D. Barišić;L. Beketić-Orešković
中科院分区：
文献类型：
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作者：
S. Orešković;D. Babić;D. Kalafatić;D. Barišić;L. Beketić-Orešković
目的通过免疫组化分析分次刮除材料中p53蛋白和Ki-67的表达以及雌激素受体（ER）和孕激素受体（PR）的状态，预测术前子宫内膜癌的生物学行为。方法选取136例原发性子宫内膜癌患者作为研究对象。136例患者均在子宫切除术前行分刮术，术后对子宫切除术标本病理组织学证实子宫内膜癌的诊断。采用单因素和多因素分析评估预后因素的重要性。采用比例风险回归法，获得ER、PR、p53、Ki-67阳性细胞在生存率判定方面的百分比截断值，作为最高卡方检验的值。采用多变量Cox回归分析来估计几种临床、病理组织学和免疫组织化学协变量对患者生存的影响。根据最近的临床状况，采用Kaplan-Meier产品限制法确定生存曲线。结果根据肿瘤的组织学类型，分次刮除标本显示组织学有利型111例（81.6%），不利型25例（18.4%）。数据显示，子宫切除术标本的ER、PR、Ki-67和p53水平与术前标本的ER、PR、Ki-67和p53水平相当一致。当p53阳性细胞比例小于15%时，最有利肿瘤分级（G I）患者预后明显较好。在组织学ⅱ级患者组中，ER表达（超过30%的阳性细胞）和p53水平（低于15%的阳性细胞）影响生存率。在组织学分级为III级的患者组中，没有任何参数具有预测性。结论我们发现通过刮除获得的组织学类型有利的高分化和中分化子宫内膜癌的免疫组化参数（ER、PR和p53）的测定可以识别预后良好的患者，这些患者不应进行根治性手术治疗。
ObjectiveThe aim of the study was to preoperatively predict the biologic behavior of the endometrial carcinoma using immunohistochemical analysis of the p53 protein and Ki-67 expression, and estrogen receptor (ER) and progesterone receptor (PR) status, in the material obtained by fractional curettage.MethodsOne hundred and thirty-six patients with primary endometrial carcinoma were included in the study. In all 136 patients, the fractional curettage was performed before the hysterectomy, and the diagnosis of endometrial carcinoma was confirmed pathohistologically after the surgical procedure on the hysterectomy specimens. The significance of the prognostic factors was assessed using univariate and multivariate analyses. The cutoff values of the percentage of ER, PR, p53, and Ki-67 positive cells in terms of survival probability determination were obtained as the values of the highest chi-square test, using proportional-risk regression method. A multivariate Cox regression analysis was performed to estimate the influence of several clinical, pathohistologic, and immunohistochemical covariates to patients' survival. Survival curves were determined by the Kaplan–Meier product-limit method based on the most recent clinical status.ResultsAccording to the histologic type of the tumor, fractional curettage specimens revealed 111 histologically favorable types (81.6%) and 25 unfavorable types (18.4%). The data indicate that ER, PR, Ki-67, and p53 levels of the hysterectomy specimens and those of the preoperative specimens were in fairly good agreement. The patients with the most favorable tumor grade (G I) had significantly better prognosis when the percentage of p53 positive cells was less than 15%. In the group of patients with histologic grade II, the survival was affected by ER expression (more than 30% of positive cells) and p53 levels (less than 15% of positive cells). None of the parameters was predictive in the group of patients with histologic grade III.ConclusionWe found that determination of immunohistochemical parameters (ER, PR, and p53) on well-differentiated and moderately differentiated endometrial carcinoma of favorable histologic type obtained by curettage enables the recognition of the patients with favorable prognosis, who should not be treated by radical surgery.