Salama Amany, Arafa Mohammad, ElZahaf Eman, Shebl Abdelhadi Mohamed, Awad Azmy Abd El-Hameed, Ashamallah Sylvia A, Hemida Reda, Gamal Anas, Foda Abd AlRahman, Zalata Khaled, Abdel-Hady El-Said M
Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Pathology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
J Pathol Transl Med. 2019 May;53(3):164-172. doi: 10.4132/jptm.2019.02.12. Epub 2019 Feb 28.
In order to improve the efficacy of endometrial carcinoma (EC) treatment, identifying prognostic factors for high risk patients is a high research priority. This study aimed to assess the relationships among the expression of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, and the different histopathological prognostic parameters in EC and to assess the value of these in the management of EC.
We examined 109 cases of EC. Immunohistochemistry for ER, PR, HER2, and Ki-67 were evaluated in relation to age, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage and grade, depth of infiltration, cervical and ovarian involvement, lymphovascular space invasion (LVSI), and lymph node (LN) metastasis.
The mean age of patients in this study was 59.8 ± 8.2 years. Low ER and PR expression scores and high Ki-67 expression showed highly significant associations with non-endometrioid histology (p = .007, p < .001, and p < .001, respectively) and poor differentiation (p = .007, p < .001, and p <. 001, respectively). Low PR score showed a significant association with advanced stage (p = .009). Low ER score was highly associated with LVSI (p = .006), and low PR scores were associated significantly with LN metastasis (p = .026). HER2 expression was significantly related to advanced stages (p = .04), increased depth of infiltration (p = .02), LVSI (p = .017), ovarian involvement (p = .038), and LN metastasis (p = .038). There was a close relationship between HER2 expression and uterine cervical involvement (p = .009). Higher Ki-67 values were associated with LN involvement (p = .012).
The over-expression of HER2 and Ki-67 and low expression of ER and PR indicate a more malignant EC behavior. An immunohistochemical panel for the identification of high risk tumors can contribute significantly to prognostic assessments.
为提高子宫内膜癌（EC）的治疗效果，确定高危患者的预后因素是一项重要的研究重点。本研究旨在评估雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER2）、Ki-67的表达与EC不同组织病理学预后参数之间的关系，并评估其在EC治疗中的价值。
我们检查了109例EC病例。评估了ER、PR、HER2和Ki-67的免疫组化与年龄、肿瘤大小、国际妇产科联盟（FIGO）分期和分级、浸润深度、宫颈和卵巢受累情况、淋巴管间隙浸润（LVSI）以及淋巴结（LN）转移之间的关系。
本研究中患者的平均年龄为59.8±8.2岁。ER和PR低表达评分以及Ki-67高表达与非子宫内膜样组织学（分别为p = 0.007、p < 0.001和p < 0.001）以及低分化（分别为p = 0.007、p < 0.001和p < 0.001）高度相关。PR低评分与晚期（p = 0.009）显著相关。ER低评分与LVSI高度相关（p = 0.006），PR低评分与LN转移显著相关（p = 0.026）。HER2表达与晚期（p = 0.04）、浸润深度增加（p = 0.02）、LVSI（p = 0.017）、卵巢受累（p = 0.038）和LN转移（p = 0.038）显著相关。HER2表达与宫颈受累之间存在密切关系（p = 0.009）。较高的Ki-67值与LN受累相关（p = 0.012）。
HER2和Ki-67的过表达以及ER和PR的低表达表明EC行为更具恶性。用于识别高危肿瘤的免疫组化检测对预后评估有显著帮助。
