子宫内膜癌分子标志物与临床病理的关系研究

目的：探索子宫内膜癌患者雌激素受体（ER）、孕激素受体（PR）、表皮生长因子受体2（CerbB-2）、增殖细胞核抗原（Ki-67）的表达以及其与临床和病理的关系。方法选择2013年8月至2014年8月于浙江省肿瘤医院行手术治疗的72例子宫内膜癌患者为研究对象，应用免疫组化法测定不同病理分期、分化程度以及浸润转移等ER、PR、CerbB-2、Ki-67各项表达情况。结果手术－病理分期Ⅲ期～Ⅳ期者ER、PR阳性率均明显低于Ⅰ期和Ⅱ期，而Ⅱ期和Ⅲ～Ⅳ期者CerbB-2、Ki-67阳性率均明显高于I期，上述差异均有统计学意义（χ2值分别为6．73、5．35、6．92、6．02、7．23、7．83、6．85、7．03，均P＜0．05）。组织学分化G3级者ER、PR阳性率均明显低于G1级和G2级者，而G2、G3级者CerbB-2、Ki-67阳性率均明显高于G1级者，且G3级者CerbB-2、Ki-67阳性率均明显高于G2级者，上述差异均有统计学意义（χ2值分别为7．53、6．68、7．90、7．24、9．22、12．64、6．82、7．53，均P＜0．05）。肌层浸润深度＞1／2者ER、PR阳性表达率均显著低于肌层浸润深度≤1／2者和无肌层浸润者，而肌层浸润深度＞1／2者CerbB-2、Ki-67阳性率显著高于肌层浸润深度≤1／2者和无肌层浸润者，且肌层浸润≤1／2者CerbB-2、Ki-67阳性率显著高于无肌层浸润者，差异均有统计学意义（χ2值分别为7．74、7．63、7．54、7．16、5．86、7．02、6．06、7．44，均P＜0．05）。有淋巴结转移者ER、PR阳性率均明显低于无淋巴结转移者，差异均有统计学意义（χ2值分别为7．74、7．63，均P＜0．05），而有淋巴结转移者和无淋巴结转移者CerbB-2、Ki-67阳性率比较无显著差异（χ2值分别为1．22、2．05，均P＞0．05）。结论 ER、PR、CerbB-2、Ki-67表达与子宫内膜癌临床和病理有密切相关性，联合应用可作为判断疾病预后和指导临床治疗的依据。

Relationship between endometrial cancer molecular markers and clinical pathology

Objective To explore the expressions of estrogen receptor ( ER ) , progesterone receptor ( PR ) , epidermal growth factor receptor 2 ( CerbB-2 ) and proliferating cell nuclear antigen ( Ki-67 ) in endometrial carcinoma and their relationship with clinics and pathology .Methods There were 72 cases with endometrial cancer undergoing surgical treatment in Zhejiang Cancer Hospital during the period of August 2013 to August 2014, and they were selected as research objects .The expressions of ER , PR, CerbB-2 and Ki-67 were determined by immunohistochemical method .Results The positive rates of ER and PR in the stage of Ⅲ-Ⅳof the operation and pathology were significantly lower than those in stage Ⅰand stage Ⅱ, while the positive rates of CerbB-2 and Ki-67 in the stage of ⅡandⅢ-Ⅳwere higher than those of stageⅠ, and the differences were statistically significant (χ2 value was 6.73, 5.35, 6.92, 6.02, 7.23, 7.83, 6.85 and 7.03, respectively, all P<0.05).The positive rates of PR and ER of G3 were lower than those of G1 and G2, the positive rates of CerbB-2 and Ki-67 of G2 and G3 were higher than those of G1, and those of G3 were obviously higher than those of G2 with significant differences (χ2 value was 7.53, 6.68, 7.90, 7.24, 9.22, 12.64, 6.82 and 7.53, respectively, all P<0.05).The positive rates of ER and PR were significantly lower and those of CerbB-2 and Ki-67 were higher in patients with myometrial invasion depth >1/2 than in those with myometrial invasion depth≤1/2 or without muscular layer infiltration , and those of CerbB-2 and Ki-67 in patients with myometrial invasion depth≤1/2 were obviously higher than those without muscular layer infiltration (χ2 value was 7.74, 7.63, 7.54, 7.16, 5.86, 7.02, 6.06 and 7.44, respectively, all P <0.05).The positive rates of ER and PR of patients with lymph node metastasis were significantly lower than those without lymph node metastasis (χ2 value was 7.74 and 7.63, respectively, both P<0.05), but the positive rates of CerbB-2 and Ki-67 were not significantly different between patients with and those without lymph node metastasis (χ2 value was 1.22 and 2.05, respectively, both P>0.05).Conclusion The expressions of ER, PR, CerbB-2 and Ki-67 are closely related to the clinical and pathological changes of endometrial carcinoma .The combined application can be used as basis for judging the prognosis and guiding clinical treatment .