子宫下段子宫内膜癌11例临床病理特征及分子分型分析

Clinicopathological features and molecular classification of lower uterine segment carcinomas:report of eleven cases

目的探讨子宫下段子宫内膜癌(LUSC)的临床病理特征、分子分型及预后。方法收集2015-06—2021-06在我科确诊的11例发生于子宫下段的子宫内膜癌病例,采用免疫组化染色和Sanger测序,明确分子分型,分析其临床病理特点,进行随访,结合文献复习,讨论治疗方案和预后。结果LUSC 11例(3%),中位年龄53岁,内膜样癌9例,透明细胞癌1例,去分化癌1例。5/11例为高级别癌(G3);所有病例均出现肌层侵犯,4/11例浸润深肌层;5/11例累及颈管间质,3/11例出现LVSI,其中1例同时出现盆腔淋巴结转移;FIGO 1期6例,FIGO 2期4例,FIGO 3期1例;4种分子亚型中POLE突变型4/11例,MMR-d型4/11例,NSMP型3/11例,无P53突变型。所有病例均接受根治手术治疗,5例术后行辅助治疗,随访时间5~76个月均无病生存。结论LUSC发病率低,平均年龄较低,高级别子宫内膜癌比例较高,易出现深肌层侵犯,LVSI发生率较高,FIGO 2期及以上占比较高,但分子分型中POLE突变型占比高,提示预后可能较好。分子分型能够为临床提供更准确的预后信息,并可能对辅助治疗方案的选择产生影响。

Objective To explore the clinicopathologic features,molecular classification and prognosis of lower uterine segment carcinomas.Methods Eleven cases of endometrial cancer in the lower segment of uterus diagnosed were collected.Immunohistochemical staining and Sanger sequencing were used to clarify the molecular classification,the clinicopathological characteristics were analyzed and followed up,and the treatment plan and prognosis were discussed with review of literature.Results LUSC accounted for 3%(11 cases)in all 364 cases diagnosed with endometrial carcinoma;median age was 53 years;9 were endometrioid carcinoma,1 was clear cell carcinoma,and 1 was dedifferentiated carcinoma.5/11 cases had poorly differentiated(G3).Muscular invasion was present in all cases,and deep muscular invasion was present in 4/11.5/11 cases involved cervical interstitium,3/11 had lymph-vascular invasion,and 1 of them had pelvic lymph node metastasis.6 patients with FIGO-1 stage,4 patients with FIGO-2 stage,and 1 patient with FIGO-3 stage.And the molecular subtypes were distributed as follows:POLE mut(4 cases),MMR-d(4 cases),NSMP(3 cases),and no P53 abn case was found.All patients were treated with radical surgery,and 5 patients received postoperative adjuvant treatment.Follow-up time was 5-72 months,and all patients were disease-free.Conclusion LUSC has a low incidence,low mean age,but high proportion of high-grade endometrial carcinoma,while prone to deep muscular invasion,and high incidence of lymph-vascular invasion,high proportion of FIGO-2 stage or above.The high proportion of POLE mutation in molecular classification probably suggests a better prognosis.Molecular typing can provide more accurate prognostic information for the clinic and may influence the selection of adjuvant therapy.