Ogane N, Yasuda M, Kato H, Kato T, Yano M, Kameda Y, Kamoshida S
Department of Pathology, Kanagawa Prefectural Ashigarakami Hospital, Matsuda, Japan.
Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan.
Cytopathology. 2018 Jun;29(3):254-261. doi: 10.1111/cyt.12550. Epub 2018 May 7.
Positive peritoneal cytology (PPC) in endometrial cancer remains a controversial topic. Cleaved caspase-3 (CC3) and Ki-67 are excellent markers of apoptotic and proliferating cells, respectively. The objective of this study was to determine the significance of CC3 and Ki-67 expression in peritoneal cytology samples as prognostic factors for endometrial cancer with PPC.
Sixty endometrial cancer specimens with PPC alone were divided into 51 endometrioid tumours (43 endometrioid carcinomas and eight carcinomas with squamous differentiation) and nine non-endometrioid tumours (two serous carcinomas, three clear cell carcinomas and four carcinosarcomas). CC3 and Ki-67 expression in peritoneal cytology samples were immunocytochemically assessed and correlated with disease-free survival (DFS) and overall survival (OS).
Expression levels of CC3 and Ki-67 were not associated with any clinicopathological parameter. Patients with non-endometrioid tumours had significantly shorter DFS (P = .001) and OS (P = .001). Low CC3 expression (CC3 ) was significantly associated with shorter OS (P = .02), but not DFS (P = .13). Multivariate analysis showed that non-endometrioid histology and CC3 were independent prognostic factors. However, Ki-67 expression was not associated with survival. When endometrioid and non-endometrioid tumours were assessed separately, CC3 was significantly associated with shorter DFS (P = .002) and OS (P = .002) in patients with non-endometrioid tumours.
Our results suggest that CC3 in peritoneal cytology samples is a poor prognostic factor in patients with endometrial cancers, especially non-endometrioid tumours. Immunocytochemical analysis of CC3 expression could potentially facilitate identification of patients with high-risk endometrial cancer with PPC.
子宫内膜癌中阳性腹膜细胞学检查（PPC）仍是一个有争议的话题。裂解的半胱天冬酶 - 3（CC3）和Ki-67分别是凋亡细胞和增殖细胞的优秀标志物。本研究的目的是确定CC3和Ki-67在腹膜细胞学样本中的表达作为伴有PPC的子宫内膜癌预后因素的意义。
60例单纯PPC的子宫内膜癌标本分为51例子宫内膜样肿瘤（43例子宫内膜样癌和8例伴有鳞状分化的癌）和9例非子宫内膜样肿瘤（2例浆液性癌、3例透明细胞癌和4例癌肉瘤）。通过免疫细胞化学评估腹膜细胞学样本中CC3和Ki-67的表达，并与无病生存期（DFS）和总生存期（OS）相关联。
CC3和Ki-67的表达水平与任何临床病理参数均无关联。非子宫内膜样肿瘤患者的DFS（P = .001）和OS（P = .001）显著较短。低CC3表达（CC3 ）与较短的OS显著相关（P = .02），但与DFS无关（P = .13）。多因素分析表明，非子宫内膜样组织学和CC3是独立的预后因素。然而，Ki-67表达与生存期无关。当分别评估子宫内膜样和非子宫内膜样肿瘤时，CC3与非子宫内膜样肿瘤患者较短的DFS（P = .002）和OS（P = .002）显著相关。
我们的结果表明，腹膜细胞学样本中的CC3是子宫内膜癌患者，尤其是非子宫内膜样肿瘤患者的不良预后因素。CC3表达的免疫细胞化学分析可能有助于识别伴有PPC的高危子宫内膜癌患者。
