Oreskovic S, Babic D, Kalafatic D, Barisic D, Beketic-Oreskovic L
Department of Obstetrics and Gynecology, School of Medicine, University of Zagreb, Zagreb, Croatia.
Gynecol Oncol. 2004 Apr;93(1):34-40. doi: 10.1016/j.ygyno.2003.12.038.
The 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.
One 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.
According 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.
We 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.
本研究旨在通过对分段刮宫获取的组织材料进行p53蛋白、Ki-67表达、雌激素受体（ER）和孕激素受体（PR）状态的免疫组化分析，术前预测子宫内膜癌的生物学行为。
136例原发性子宫内膜癌患者纳入本研究。所有136例患者均在子宫切除术前进行分段刮宫，子宫切除标本手术后经病理组织学确诊为子宫内膜癌。采用单因素和多因素分析评估预后因素的意义。使用比例风险回归方法，以最高卡方检验值作为确定生存概率时ER、PR、p53和Ki-67阳性细胞百分比的临界值。进行多因素Cox回归分析，以评估几种临床、病理组织学和免疫组化协变量对患者生存的影响。根据最新临床状态，采用Kaplan-Meier乘积限界法确定生存曲线。
根据肿瘤的组织学类型，分段刮宫标本显示111例组织学类型良好（81.6%），25例不良（18.4%）。数据表明，子宫切除标本和术前标本的ER、PR、Ki-67和p53水平相当一致。p53阳性细胞百分比小于15%时，肿瘤分级最有利（G I）的患者预后明显更好。在组织学分级为II级的患者组中，生存受ER表达（阳性细胞超过30%）和p53水平（阳性细胞小于15%）影响。在组织学分级为III级的患者组中，没有参数具有预测性。
我们发现，对刮宫获得的组织学类型良好的高分化和中分化子宫内膜癌进行免疫组化参数（ER、PR和p53）测定，能够识别预后良好、不应接受根治性手术治疗的患者。
