子宫内膜癌中Maspin的表达及其与雌激素受体表达的相关性研究

Expression of maspin and its correlation with estrogen receptor in endometrial carcinoma.

目的：检测Maspin蛋白在正常子宫内膜、不典型增生及内膜癌组织中的表达，及其与雌激素受体（En）表达的关系，探讨Maspin在子宫内膜癌发生中的作用及其作用机制。方法：免疫组化SP法检测40例子宫内膜腺癌、18例不典型增生及10例正常子宫内膜（对照组）中Maspin蛋白的表达及其与子宫内膜癌患者临床病理特征和ER蛋白表达的关系。结果：Maspin阳性表达在正常子宫内膜组最高（9／10，90％），高于内膜不典型增生组（10／18，55．6％）和内膜癌组（17／40，42．5％），差异有统计学意义（P〈0．05），在内膜癌中FIGOⅠ期的表达（13／20，65．0％）明显高于Ⅱ-Ⅲ期（4／20，20．0％；P〈0．05），无淋巴结转移者（17／34，50．0％）明显高于有淋巴结转移者（0／6；P=0．030），但与组织学分级及肌层浸润程度无关（P〉0．05）。ER在正常子宫内膜、内膜不典型增生及内膜癌组织的阳性表达率分别为（10／10，100．0％）、（13／18，72．2％）和（20／40，50．0％），各组间差异有统计学意义（P〈0．05）；内膜癌组织中FIGOI期的表达（14／20，70．0％）明显高于Ⅱ-Ⅲ期（6／20，30．0％；P〈0．05）；内膜癌高、中、低分化组中ER表达率分别为（11／15，73．3％）、（8／18，44．4％）、（1／7，14．3％），组间差异有统计学意义（P〈0．05）；无淋巴结转移者（20／34，58．8％）明显高于有淋巴结转移者（0／6；P=0．020），肌层浸润≤1／2者（16／24，66．7％）明显高于肌层浸润〉1／2者（4／16，25．0％；P〈0．05）。子宫内膜癌中，Maspin的表达与ER的表达存在正相关关系（r=0．394，P〈0．05）。结论：从正常子宫内膜、内膜不典型增生到内膜癌，Maspin蛋白表达逐渐降低，且其低表达与子宫内膜癌临床分期晚、淋巴结转移有关，并与ER蛋白表达呈一致性，提示Maspin蛋白的表达可能受雌激素调控，参与了子宫内膜癌发生发展和转移过程。

Objective： To study the expression levels of maspin protein in normal endometrium, atypical hyperplasia of endometrium and endometrial carcinoma, and also its correlation with estrogen receptor, in order to investigate its role and mechanism in the tumorigenesis and development of endometrial carcinoma. Methods： Forty cases of endometrial carcinoma and eighteen cases of atypical hyperplasia of endometrium were selected in this study. Ten cases of normal endometrium in proliferative phase obtained by diagnostic dilatation and curettage of other reasons were used as the control group. Immunohistochemistry was used to study the expression of maspin, as well as estrogen receptor. Results：Maspin protein had the highest expression in the control group（9/10,90% ） ,much higher than that in the atypical hyperplasia group（ 10/ 18,55.6% ） and the malignant group（17/40,42.5% ） where difference was statistically signif-icant among the three groups （P 〈 0. 05 ）. In endometrial carcinoma, the expression rate and level of maspin in FIGO stage Ⅰ （13/20,65%） were higher than that in stage Ⅱ -Ⅲ （4/20,20. 0% ;P 〈 0. 05 ）, and significant difference was observed in the expression of maspin between It lymph metastases（0/6）and the negative ones（ 17/34,50% ; P = 0.030）. ER protein had the lowest expression in the malignant group（50.0% ） ,much lower than that in the atypical hyperplasia group（72.2% ） and the control group（ 100% ） ,where difference was statistically signifi- cant （P 〈 0.05 ）. In the endometrial carcinoma group, the expression level of ER was higher in the cases of stage Ⅰ （ 14/20,70. 0% ）, of well differentiated （ 11/15,73.3% ）, of superficial myometrial invasion （ 16/24,66. 7% ） and of negtive lymph metastases （ 20/34,58.8% ） than those of stage Ⅱ-Ⅲ （6/20,30.0 % ）, of moderately （ 8/18,44.4% ） and poorly （ 1/7,14.3 % ） differentiated, of deep myometrial invasion （ 4/16,25.0 % ） and positive lymph metastases （ 0/6 ） （ P 〈0.05 ;P 〈0.05 ;P 〈0.05 ; P = 0. 020 ）. There was positively correlation between maspin and ER expression（ r = 0. 556, P 〈 0.05 ）. Conclution： From the control group to the atypical hyperplasia group and the malignant group, the expression of maspin degraded, and its down-expression is closely related to late FIGO stage as well as negative lymph node metastases. The level of maspin expression may be regulated by estrogen and it take part in the tumorigenesis, development and metastasis of endometrial carcinoma.