Garzetti G G, Ciavattini A, Goteri G, De Nictolis M, Romanini C
Department of Obstetrics and Gynecology, Ancona University, Ancona, Italy.
Gynecol Oncol. 1996 Apr;61(1):16-21. doi: 10.1006/gyno.1996.0089.
The aim of our study was to retrospectively examine the proliferating cell nuclear antigen (PCNA) immunoreactivity of tumor cells in curettage specimens containing endometrioid adenocarcinoma and obtained immediately before definitive surgical staging. This PCNA index was compared with the one subsequently derived from surgical specimens and assessed as a function of histologic grade, depth of myometrial invasion, neoplastic nodal involvement, cervical spread, and progression-free survival in order to determine a new prognostic parameter valuable at the time of diagnosis.
A population of 79 patients with locally advanced (stage I and II) endometrioid carcinoma, who underwent both the preliminary diagnostic curettage and the subsequent definitive surgical management, selected from January 1986 to June 1993 at the Department of Gynecology and Obstetrics, Ancona University, was retrospectively recruited from our series of 99 endometrial carcinomas. The archival paraffin blocks from the curettage and uterine specimens were identified and assessed for histologic reexamination and PCNA immunostaining [PC10 monoclonal antibody (Dako, Denmark)].
After a median follow-up of 47 months, recurrences were detected in 7 cases, and the Kaplan-Meier disease-free survival curve estimated for the entire study group was 91%. The median PCNA index of the curettage specimens presented a good overlap with the PCNA immunostaining in corresponding uterine samples with a correlation coefficient of 0.4 (P=0.02). A PCNA index >/=30% in curettage specimen was predictive of deep myometrial invasion; of 35 patients with PCNA index > or = 30%, 29 (83%) had myometrial invasion > or = 50%. No significant relationship was observed with neoplastic cervical spread, and histologic differentiation. By Cox hazard analysis, the PCNA index evaluated on curettage specimens was significantly related to disease-free survival, with significant disease-free survival advantages for patients with PCNA <30% (P<0.001).
Our findings suggest that the PCNA immunostaining has proved to be considerably promising for the risk assessment in locally advanced endometrial carcinoma. The PCNA index is an objective and reproducible parameter accruably valuable also before starting the treatment; in presence of a high PCNA index, the patients should be referred to gynecologic oncologists for appropriate management.
本研究旨在回顾性检测在包含子宫内膜样腺癌的刮宫标本中肿瘤细胞的增殖细胞核抗原（PCNA）免疫反应性，这些标本是在确定性手术分期前即刻获取的。将该PCNA指数与随后从手术标本中得出的指数进行比较，并根据组织学分级、肌层浸润深度、肿瘤性淋巴结受累情况、宫颈扩散情况及无进展生存期进行评估，以确定一个在诊断时具有重要价值的新的预后参数。
从安科纳大学妇产科1986年1月至1993年6月期间收治的99例子宫内膜癌患者中，回顾性选取79例局部晚期（I期和II期）子宫内膜样癌患者，这些患者均接受了初步诊断性刮宫及随后的确定性手术治疗。对刮宫标本和子宫标本的存档石蜡块进行识别，并进行组织学复查和PCNA免疫染色[PC10单克隆抗体（丹麦达科公司）]评估。
中位随访47个月后，7例患者出现复发，整个研究组的Kaplan-Meier无病生存曲线估计值为91%。刮宫标本的中位PCNA指数与相应子宫样本中的PCNA免疫染色呈现出良好的重叠，相关系数为0.4（P = 0.02）。刮宫标本中PCNA指数≥30%可预测肌层深度浸润；在35例PCNA指数≥30%的患者中，29例（83%）肌层浸润≥50%。未观察到与肿瘤性宫颈扩散及组织学分化有显著关系。通过Cox风险分析，刮宫标本上评估的PCNA指数与无病生存期显著相关，PCNA<30%的患者无病生存期有显著优势（P<0.001）。
我们的研究结果表明，PCNA免疫染色在局部晚期子宫内膜癌的风险评估中已被证明具有很大前景。PCNA指数是一个客观且可重复的参数，在开始治疗前也具有相当大的价值；若PCNA指数较高，患者应转诊至妇科肿瘤学家处进行适当管理。
