卵巢透明细胞癌形态学及免疫组织化学表达与预后关系的研究

Correlation between morphology and immunohistochemical expressions and prognosis in clear cell carcinoma of ovary

目的探讨卵巢透明细胞癌病理形态学、p53、Cyclin E、CD44_(V6)与预后的关系。方法收集解放军总医院1981-2002年间卵巢透明细胞癌手术切除病理标本28例,收集临床资料,判断临床分期;复习病理大体及镜下特点;对24例卵巢透明细胞癌患者行p53、Cyclin E与CD44_(V6)免疫组化染色;对全部28例卵巢透明细胞癌患者进行随访,随访时间为4～240个月。结果临床资料显示患者5年生存率为49.24%。其中Ⅰ期、Ⅱ期患者预后明显好于Ⅲ期患者。大体检查显示肿瘤最大直径<12cm的患者预后好于直径≥12cm的患者。显微镜检查显示合并子宫内膜异位症的患者预后好于不合并子宫内膜异位症的患者。细胞类型以透明细胞为主者型9例中死亡2例;以鞋钉细胞为主和透明细胞与鞋钉细胞共存者15例中死亡10例,两组生存时间差异有统计学意义。p53的表达与卵巢透明细胞癌患者生存时间没有相关性。24例卵巢透明细胞癌Cy-clinE均为阳性,阳性表达强弱与预后无明显相关性。24例卵巢透明细胞癌中13例CD44_(V6)阳性,CD44_(V6)表达组预后明显比非表达组差。结论肿瘤大、未合并子宫内膜异位、以鞋钉细胞为主预后较差;p53在卵巢透明细胞癌中表达率较低(25%),其表达与卵巢透明细胞癌患者生存时间没有相关性。cyclin E是卵巢透明细胞癌较理想的诊断标志物,在其病理诊断和鉴别诊断方面有较大价值。CD44_(V6)在卵巢CCC中的表达与预后密切关系,可以作为预测肿瘤转移潜能、评估预后的指标。

Objective To study the features of pathologic morphology and the expressions of p53,cyclin E,CD44V6in clear cell carcinoma,and their relationship with patients’ survival.Methods Twenty-four patients with clear cell carcinoma of ovary （CCCO）were studied by clinical data analysis,pathologic morphology and p53,CyclinE,CD44V6of immunohistochemical staining.The follow-up information was also analyzed.Results Among the 24 patients with CCCO the 5-year survival rate was 49.24%.The prognosis of patients in stage Ⅰ and Ⅱ was better than that of patients in stage Ⅲ（P12 cm（P=0.023）.The prognosis of CCCO with endometriosis was better than that of CCCO without endometriosis（P=0.009）.Two of the nine（22%）patients with predominant clear cells died and ten of the fifteen patients（66%） with hobnail cells and mixed clear-hobnail cells died.There was significant diffirenee between the two groups in survival time（P= 0.05）,but not between the patieuts with and without the expression of p53（P=0.885）.All the twenty-four cases of CCCO expressed cyclin E.There was significant difference in prognosis between the patients with and without expression of CD44V6,The prognosis of patients with positive CD44V6was worse than that of patients with negative CD44V6.（P=0.001）.Conclusions The worse prognosis in patients with CCCO is correlated with tumor size,presence of endometriosis and the hobnail tumor cell type.There is no prognostic significance for expression of p53.Cyclin E is a better marker for pathologic diagnosis of CCCO.The expression of CD44V6 correlates with survival and prognosis.