Impact of TP53 immunohistochemistry on the histological grading system for endometrial endometrioid carcinoma
Impact of TP53 immunohistochemistry on the histological grading system for endometrial endometrioid carcinoma
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DOI：
10.1038/s41379-019-0220-1
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发表时间：
2019-07-01
期刊：
影响因子：
7.5
通讯作者：
Yasuda, Masanori
中科院分区：
文献类型：
--
作者：
Yano, Mitsutake;Ito, Kozue;Yasuda, Masanori
子宫内膜癌通常分为三个组织学亚组：1级（G1），2级（G2）和3级（G3）。G1/2期子宫内膜样癌大多数病例预后良好，但有些病例可能预后不良，特别是当涉及老年患者时，与G3期子宫内膜样癌和浆液性癌相似。这项回顾性研究评估了TP 53异常是否可以用于补充目前的分级系统，并提高其预测临床结果的能力。应用组织芯片技术对475例子宫内膜类腺癌手术切除标本进行了TP 53的免疫组化分析。弱或中度表达定义为TP 53-正常表达，而缺失或强阳性表达定义为TP 53-异常表达。子宫内膜样癌最初诊断为G1（69%），G2（18%）和G3（13%）。单变量分析显示，TP 53异常表达与G1和G2病例的生存率低相关，但与G3病例无关。此外，年龄（≥ 60岁）与G1病例中TP 53异常表达相关（3% vs. 16%，p = 0.001），但与G2或G3病例无关。基于免疫组化TP 53表达，使用预后分级系统将子宫内膜类腺瘤重新分类为高级别（G1或G2与TP 53-异常表达，G3与TP 53-正常或异常表达）或低级别（G1或G2与TP 53-正常表达）。多变量分析显示，预后分级系统（使用组织学分级和TP 53表达）可以独立预测不良无进展生存期（风险比：2.91，p < 0.001）和总生存期（风险比：3.62，p < 0.001）。因此，将免疫组化TP 53表达与传统的子宫内膜样癌组织学分级系统相结合，可能有助于提高其准确预测患者预后的能力。
Endometrial endometrioid carcinoma is usually divided into three histological subgroups: grade 1 (G1), grade 2 (G2), and grade 3 (G3). Most cases of endometrial endometrioid carcinoma G1/2 have a favorable prognosis, although some can have unfavorable outcomes, especially when they involve elderly patients, with similarities to endometrioid carcinoma G3 and serous carcinoma. This retrospective study evaluated whether TP53 abnormalities in endometrial endometrioid carcinoma could be used to supplement the current grading system and improve its ability to predict clinical outcomes. Immunohistochemical expression of TP53 was analyzed using tissue microarrays from the surgically resected specimens of 475 patients with endometrial endometrioid carcinoma. Weak or moderate expression was defined as TP53-normal expression, while absent or strongly positive expression was defined as TP53-aberrant expression. The endometrial endometrioid carcinomas had originally been diagnosed as G1 (69%), G2 (18%), and G3 (13%). Univariate analyses revealed that TP53-aberrant expression was associated with poor survival in G1 and G2 cases, but not G3 cases. In addition, age (= 60 years) was correlated with TP53-aberrant expression in G1 cases (3% vs. 16%, p = 0.001), but not in G2 or G3 cases. Based on immunohistochemical TP53 expression, the endometrial endometrioid carcinomas were reclassified using a prognostic grading system as high-grade (G1 or G2 with TP53-aberrant expression, and G3 with TP53-normal or -aberrant expression) or low-grade (G1 or G2 with TP53-normal expression). The multivariate analyses revealed that the prognostic grading system (using histological grade and TP53 expression) could independently predict poor progression-free survival (hazard ratio: 2.91, p < 0.001) and overall survival (hazard ratio: 3.62, p < 0.001). Therefore, combining immunohistochemical TP53 expression with the traditional histological grading system for endometrial endometrioid carcinoma may help improve its ability to accurately predict the patient's prognosis.