Johnson G A, Mannel R, Khalifa M, Walker J L, Wren M, Min K W, Benbrook D M
Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.
Gynecol Oncol. 1997 Jun;65(3):425-9. doi: 10.1006/gyno.1997.4660.
To evaluate the level of epidermal growth factor receptor (EGF-R) expression in vulvar malignancies and to determine if a correlation exists between EGF-R levels and metastasis or patient survival.
All patients with a diagnosis of invasive squamous cell carcinoma of the vulva who were treated at our institution with a primary radical vulvectomy and inguinal lymph node dissection from 1983 to 1993 were eligible for the study. Sixty-one patients with available tissue blocks of benign vulvar epithelium, the primary malignant vulvar lesion, and groin node metastasis (when positive) were included in the study. Semiquantitative EGF-R expression was determined in a blinded fashion utilizing immunohistochemical staining of appropriate tissue samples. Survival was calculated utilizing Kaplan-Meier life table analysis based upon disease-free survival.
A significant increase (P < 0.001) in mean EGF-R levels was demonstrated in the primary tumor (67%) versus benign vulvar epithelium (31%). In the 14 patients with lymph node metastasis, the mean EGF-R level in the primary tumor was 65% versus 88% in the metastatic lesion (P < 0.001). The likelihood of lymph node metastasis was elevated in those patients with a benign tissue EGF-R level > or =40% (P < 0.03) and in those patients with a primary tumor EGF-R level > or =90% (P < 0.025). Life table analysis revealed a cumulative disease-free survival of 45% for all patients. Disease-free survival in those patients with EGF-R levels > or =90% in the primary tumor was 25%, contrasting with a disease-free survival of 54% in those patients with EGF-R levels <90% (P < 0.05).
There is a progressive increase in EGF-R expression from benign vulvar epithelium to primary malignant tissue to metastatic lesions within the same patient. Increased expression of EGF-R in the primary vulvar malignancy is significantly associated with lymph node metastasis and decreased patient survival. Increased expression of EGF-R in histologically benign vulvar epithelium has a significant association with lymph node metastasis and may predict decreased patient survival.
评估外阴恶性肿瘤中表皮生长因子受体（EGF-R）的表达水平，并确定EGF-R水平与转移或患者生存率之间是否存在相关性。
所有在1983年至1993年期间于我院接受原发性根治性外阴切除术及腹股沟淋巴结清扫术治疗的浸润性外阴鳞状细胞癌患者均符合本研究条件。本研究纳入了61例有良性外阴上皮、原发性恶性外阴病变及腹股沟淋巴结转移（若为阳性）的可用组织块的患者。利用适当组织样本的免疫组织化学染色，以盲法测定EGF-R的半定量表达。基于无病生存期，采用Kaplan-Meier生存表分析法计算生存率。
与良性外阴上皮（31%）相比，原发性肿瘤中平均EGF-R水平显著升高（P<0.001）（67%）。在14例有淋巴结转移的患者中，原发性肿瘤的平均EGF-R水平为65%，而转移灶中为88%（P<0.001）。良性组织EGF-R水平≥40%的患者（P<0.03）及原发性肿瘤EGF-R水平≥90%的患者（P<0.025）发生淋巴结转移的可能性升高。生存表分析显示，所有患者的累积无病生存率为45%。原发性肿瘤中EGF-R水平≥90%的患者无病生存率为25%，而EGF-R水平<90%的患者无病生存率为54%（P<0.05）。
在同一患者中，从良性外阴上皮到原发性恶性组织再到转移灶，EGF-R表达呈逐渐升高趋势。原发性外阴恶性肿瘤中EGF-R表达增加与淋巴结转移及患者生存率降低显著相关。组织学上良性的外阴上皮中EGF-R表达增加与淋巴结转移显著相关，且可能预示患者生存率降低。
