TCGA 分类和 SWI/SNF 蛋白表达在未分化/去分化子宫内膜癌中的临床病理意义：一种可能的预后风险分层。

Clinico-pathological significance of TCGA classification and SWI/SNF proteins expression in undifferentiated/dedifferentiated endometrial carcinoma: A possible prognostic risk stratification.

机构信息

Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Roma, Italy.

Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131 Naples, Italy.

出版信息

Gynecol Oncol. 2021 May;161(2):629-635. doi: 10.1016/j.ygyno.2021.02.029. Epub 2021 Mar 10.

DOI:10.1016/j.ygyno.2021.02.029

PMID:33712277

Abstract

BACKGROUND

Undifferentiated/dedifferentiated endometrial carcinoma (UEC/DDEC) is a heterogeneous entity, which may show any of the TCGA molecular signatures and loss of the switch/sucrose nonfermentable (SWI/SNF) proteins expression.

AIM

To assess the clinico-pathological significance of the TCGA molecular groups and SWI/SNF proteins expression in UEC/DDEC, through a quantitative systematic review.

METHODS

Electronic databases were searched for all studies assessing the TCGA molecular groups, i.e. POLE-mutant, mismatch repair-deficient (MMRd), p53-abnormal (p53abn) and no specific molecular profile (NSMP), and/or the SWI/SNF proteins (SMARCA4/BRG1, SMARCB1/INI1, ARID1B) expression in UEC/DDEC. Student t-test, Fisher's exact test and Kaplan-Meier survival analysis with long-rank test were used to assess differences among groups; a p-value<0.05 was considered significant.

RESULTS

Eight studies were included in the systematic review. Among the TCGA groups, the mean patient age was significantly higher in the p53abn group than in the NSMP group (p = 0.048). The POLE-mutant group showed advanced FIGO stage (III-IV) significantly less commonly than the NSMP (p = 0.003) and MMRd (p = 0.008) groups, and a significantly better prognosis than the NSMP (p = 0.007), MMRd (p = 0.011) and p53abn (p = 0.045) groups.The SWI/SNF-deficient cases showed a significantly worse prognosis than the SWI/SNF-intact cases (p = 0.010), while no significant differences were found regarding patient age and FIGO stage.

CONCLUSIONS

Among UEC/DDEC, POLE-mutant cases show good prognosis, while SWI/SNF-deficient cases show poor prognosis. The other TCGA molecular subtypes seem to be characterized by an intermediate biological behaviour. On this account, UEC/DDEC patients might be subdivided into three risk groups based on POLE and SWI/SNF status. Further studies are necessary in this field.

摘要

背景

未分化/去分化子宫内膜癌（UEC/DDEC）是一种异质性实体，可能表现出 TCGA 分子特征中的任何一种，以及 SWI/SNF 蛋白表达缺失。

目的

通过定量系统评价评估 UEC/DDEC 中 TCGA 分子分组和 SWI/SNF 蛋白表达的临床病理意义。

方法

电子数据库检索了所有评估 TCGA 分子分组的研究，即 POLE 突变、错配修复缺陷（MMRd）、p53 异常（p53abn）和无特定分子谱（NSMP），以及 UEC/DDEC 中 SWI/SNF 蛋白（SMARCA4/BRG1、SMARCB1/INI1、ARID1B）的表达。使用学生 t 检验、Fisher 确切检验和 Kaplan-Meier 生存分析（带有 Long-rank 检验）评估组间差异；p 值<0.05 被认为具有统计学意义。

结果

系统评价共纳入 8 项研究。在 TCGA 分组中，p53abn 组患者的平均年龄明显高于 NSMP 组（p=0.048）。POLE 突变组患者的 FIGO 分期（III-IV 期）明显低于 NSMP 组（p=0.003）和 MMRd 组（p=0.008），且预后明显优于 NSMP 组（p=0.007）、MMRd 组（p=0.011）和 p53abn 组（p=0.045）。SWI/SNF 缺失组患者的预后明显差于 SWI/SNF 完整组（p=0.010），而两组患者的年龄和 FIGO 分期无显著差异。