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采用雌激素受体免疫组化对 NSMP 高危型子宫内膜癌进行预后细化。

Prognostic refinement of NSMP high-risk endometrial cancers using oestrogen receptor immunohistochemistry.

机构信息

Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.

Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, The Netherlands.

出版信息

Br J Cancer. 2023 Mar;128(7):1360-1368. doi: 10.1038/s41416-023-02141-0. Epub 2023 Jan 23.


DOI:10.1038/s41416-023-02141-0
PMID:36690721
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10050005/
Abstract

BACKGROUND: Risk-assessment of endometrial cancer (EC) is based on clinicopathological factors and molecular subgroup. It is unclear whether adding hormone receptor expression, L1CAM expression or CTNNB1 status yields prognostic refinement. METHODS: Paraffin-embedded tumour samples of women with high-risk EC (HR-EC) from the PORTEC-3 trial (n = 424), and a Dutch prospective clinical cohort called MST (n = 256), were used. All cases were molecularly classified. Expression of L1CAM, ER and PR were analysed by whole-slide immunohistochemistry and CTNNB1 mutations were assessed with a next-generation sequencing. Kaplan-Meier method, log-rank tests and Cox's proportional hazard models were used for survival analysis. RESULTS: In total, 648 HR-EC were included. No independent prognostic value of ER, PR, L1CAM, and CTNNB1 was found, while age, stage, and adjuvant chemotherapy had an independent impact on risk of recurrence. Subgroup-analysis showed that only in NSMP HR-EC, ER-positivity was independently associated with a reduced risk of recurrence (HR 0.33, 95%CI 0.15-0.75). CONCLUSIONS: We confirmed the prognostic impact of the molecular classification, age, stage, and adjuvant CTRT in a large cohort of high-risk EC. ER-positivity is a strong favourable prognostic factor in NSMP HR-EC and identifies a homogeneous subgroup of NSMP tumours. Assessment of ER status in high-risk NSMP EC is feasible in clinical practice and could improve risk stratification and treatment.

摘要

背景:子宫内膜癌(EC)的风险评估基于临床病理因素和分子亚组。目前尚不清楚是否增加激素受体表达、L1CAM 表达或 CTNNB1 状态可以改善预后。

方法:使用 PORTEC-3 试验(n=424)中高危 EC(HR-EC)的石蜡包埋肿瘤样本和荷兰前瞻性临床队列 MST(n=256)。所有病例均进行分子分类。通过全切片免疫组织化学分析 L1CAM、ER 和 PR 的表达,并用下一代测序评估 CTNNB1 突变。采用 Kaplan-Meier 法、log-rank 检验和 Cox 比例风险模型进行生存分析。

结果:共纳入 648 例 HR-EC。未发现 ER、PR、L1CAM 和 CTNNB1 的独立预后价值,而年龄、分期和辅助化疗对复发风险有独立影响。亚组分析显示,仅在 NSMP HR-EC 中,ER 阳性与复发风险降低独立相关(HR 0.33,95%CI 0.15-0.75)。

结论:我们在一个大型高危 EC 队列中证实了分子分类、年龄、分期和辅助 CTRT 的预后影响。ER 阳性是 NSMP HR-EC 的一个强烈有利的预后因素,并确定了一个同质的 NSMP 肿瘤亚组。在高危 NSMP EC 中评估 ER 状态在临床实践中是可行的,并且可以改善风险分层和治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2083/10050005/0691ce2a82a8/41416_2023_2141_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2083/10050005/99e50f60b88e/41416_2023_2141_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2083/10050005/b6afb6d0e552/41416_2023_2141_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2083/10050005/0691ce2a82a8/41416_2023_2141_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2083/10050005/99e50f60b88e/41416_2023_2141_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2083/10050005/b6afb6d0e552/41416_2023_2141_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2083/10050005/0691ce2a82a8/41416_2023_2141_Fig3_HTML.jpg

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本文引用的文献

[1]
Mullerian adenosarcoma: clinicopathologic and molecular characterization highlighting recurrent BAP1 loss and distinctive features of high-grade tumors.

Mod Pathol. 2022-11

[2]
Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.

Ann Oncol. 2022-9

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Mesonephric-like Adenocarcinoma of the Female Genital Tract: From Morphologic Observations to a Well-characterized Carcinoma With Aggressive Clinical Behavior.

Adv Anat Pathol. 2022-7-1

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Am J Surg Pathol. 2022-7-1

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Gynecol Oncol. 2022-3

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Int J Gynecol Pathol. 2022-5-1

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Int J Gynecol Cancer. 2021-1

[9]
Molecular Classification of the PORTEC-3 Trial for High-Risk Endometrial Cancer: Impact on Prognosis and Benefit From Adjuvant Therapy.

J Clin Oncol. 2020-10-10

[10]
Molecular subtypes of clear cell carcinoma of the endometrium: Opportunities for prognostic and predictive stratification.

Gynecol Oncol. 2020-7

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