PAX-2、PTEN、ER和Ki-67在子宫内膜癌及其癌前病变组织中的表达及意义

The expression and significance of PAX-2,PTEN,ER and Ki-67 in endometrial carcinoma and its precancerous lesions

目的研究配对盒基因2(PAX-2)、人第10号染色体缺失的磷酸酶及张力蛋白同源基因(PTEN)、雌激素受体(ER)和肿瘤增殖抗原(Ki-67)在子宫内膜癌及其癌前病变组织中的表达及意义。方法回顾性分析2014年1月至2017年1月在首都医科大学大兴医院行分段诊刮术或全子宫切除术并经组织病理学检查诊断明确的66例患者的病例资料。其中包括子宫内膜非典型增生19例,局灶癌变(<2 mm)10例,子宫内膜样腺癌37例及其中37例肿瘤旁具有增生期子宫内膜的组织,行PAX-2、PTEN、ER及Ki-67免疫组织化学染色。观察PAX-2、PTEN、ER和Ki-67在增生期子宫内膜、子宫内膜非典型增生、子宫内膜局灶癌变、子宫内膜样腺癌中的表达情况。结果 PAX-2、PTEN、ER在子宫内膜非典型增生组、局灶癌变组、子宫内膜样腺癌组中的表达明显减弱或失表达,与肿瘤旁增生期子宫内膜比较,差异均有统计学意义(P<0.01)。在37例增生期子宫内膜中绝大部分组织Ki-67增殖指数<5%(97.3%),而在子宫内膜非典型增生组、局灶癌变组及子宫内膜样腺癌组中的表达明显增多(大部分病例组织Ki-67增殖指数>5%,大于5%的阳性率分别为79.0%、80.0%、94.6%),与肿瘤旁增生期子宫内膜比较,差异具有显著统计学意义(P<0.01)。结论 PAX-2、PTEN、ER及Ki-67的免疫组织化学检测可以简单、方便地判断子宫内膜癌及其癌前病变的严重程度,对于协助子宫内膜癌及其癌变病变的早期诊断、指导临床治疗及评估预后有重要意义,可以联合应用于子宫内膜癌的早期筛查。

Objective To study the expression and significance of PAX-2,PTEN,ER and Ki-67 in the tissue of endometrial carcinoma and precancerous lesions. Methods 66 cases of patients underwent dilatation and curettage or hysterectomy with a clear inspectiaon and pathological diagnosis were retrospectively collected from January 2014 to January 2017 in Daxing Hospital,including 19 cases of endometrial atypical hyperplasia,10 cases of focal carcinogenenesis（ 2 mm）,37 cases of endometrioid adenocarcinoma and 37 cases of hyperplasia endometrium which adjacent to the aboved endometrioid adenocarcinoma and its precancerous lesions by immunohistochemical staining of PAX-2,PTEN,ER and Ki-67. Results The expression of PTEN,PAX-2,ER in endometrial atypical hyperplasia group,focal carcinogenenesis group,endometrioid adenocarcinoma group were significantly decreased or loss of expression,compared with the hyperplasia endometrium which adjacent to the endometrioid adenocarcinoma and its precancerous lesions,there were statistically significant difference（ all P〈0. 01）. The proliferation index of Ki-67 in 37 cases of the hyperplasia endometrium was mostly 5 %（ 97. 3 %）,but in atypical endometrial hyperplasia,focal carcinogenenesis and endometrioid adenocarcinoma group the Ki-67 proliferation index were significantly increased（ mostly more than5 %,the positive rates were 79 %,80 %,94. 6 % respectively）,compared with the hyperplasia endometrium which adjacent to the endometrioid adenocarcinoma and its precancerous lesions（ P〈0. 01）. Conclusion Detection of PAX-2,PTEN,ER and Ki-67 by immunohistochemical staining is simple and convenient,which can be used to observe the severity of atypical endometrial hyperplasia,focal carcinogenenesis and endometrioid adenocarcinoma,and it is useful for the early diagnosis,guiding the clinical treatment and assessment of prognosis of endometrioid adenocarcinoma and its precancerous lesions. Combination detection of PAX-2,PTEN,ER and Ki-67 can be used as screening methods for early endometrioid adenocarcinoma.