卵巢浆液性癌两级组织学分级系统的评估及p53蛋白过表达的意义

Evaluation of two-tier grading system and significance of p53 protein over-expression in ovarian serous carcinoma

目的 评估卵巢浆液性癌的M.D.Anderson肿瘤中心（MDACC）的两级组织学分级系统在临床诊断和预后判断中的可行性和有效性,并与WHO组织学分级系统进行比较,同时探讨p53蛋白对卵巢浆液性癌分级的辅助作用及其在预后与治疗中的意义.方法 对72例卵巢浆液性癌患者病理资料进行MDACC两级分级和WHO分级,将分级结果与临床指标进行统计学分析.用免疫组织化学EnVision法检测p53蛋白在肿瘤组织中的表达水平,分析其与组织学分级及临床指标的相关性.结果 MDACC分级与WHO分级显示出较好的相关性（r=0.534,P=0.000）.虽然两种分级方法均未与无病生存期（P=0.170和0.075）、肿瘤细胞减灭术（P=0.478和0.120）及以铂类为基础的初次化疗效果（P=0.418和0.403）显示出明确的相关性,但与WHO分级相比,MDACC分级与肿瘤分期（P=0.041和0.002）、3年无病生存率（P=0.077和0.004）、总生存期（P=0.080和0.046）和p53免疫组织化学染色结果（P=0.334和0.035）具有更好的显著性相关.此外,p53免疫组织化学染色结果与其他各项临床指标之间未显示出显著的相关性.结论 MDACC分级较WHO分级系统能更好地提示预后,比较符合最新的卵巢浆液性癌不同通路发病学说,临床应用前景良好,但仍需完善和进一步检验.单纯的p53免疫组织化学染色结果有助于辅助卵巢浆液性癌的MDACC分级,但对于判断预后的价值有限,需慎重使用.

Objective To evaluate the two-tier MDACC grading system for ovarian serous carcinoma by comparing with the WHO grading system, and to investigate the role of p53 immunostaining in ovarian serous carcinoma grading. Methods 72 cases ovarian serous carcinoma of ovary were graded basing on the MDACC and WHO grading systems,respectively. Statistic analyses were made for the relationship between the data obtained from two grading systems and their clinical significance. All the cases were examined immunohistochemically by using antibody against p53 protein and the immunohistochemistry findings were analyzed with the two grading systems and clinical parameters. Results There was a good correlation between the MDACC and WHO grading system （ r = 0.543, P = 0.000）. Neither system has a definite relationship with the disease-free survival time （P = 0.170 vs. P = 0.075 ）, cytoreduction （ P = 0.478 vs.P = 0.120）, and the curative effect of platinum-based chemotherapy （ P = 0.418 vs. P = 0.403 ）. However,compared with the WHO grading system, MDACC grading system has a better correlation with tumor stage （ P = 0.041 vs. P = 0.002）, 3-year disease-free survival rate （ P = 0.077 vs. P = 0.004）, overall survival time （P= 0.080 vs. P = 0.046）, and p53 immunohistochemistry results （P = 0.334 vs. P = 0.035）. No significant difference was found between p53 immunohistochemistry results with other clinical characteristics and prognostic factors. Conclusions Compared with the WHO system, the MDACC system showed a better prognostic value and was more likely correlated with the novel dualistic model for ovarian serous carcinogenesis. Although p53 immunostaining was valuable in assisting MDACC grading, it should be cautious to use it alone as an independent indicator in predicting the prognosis of ovarian serous carcinoma.