子宫内膜癌组织中PR及其亚型PRA、PRB的表达变化及意义

Clinical significance of progesterone receptors A and B expressions in endometrial carcinoma

目的观察子宫内膜癌组织中孕激素受体(PR)及其亚型PRA、PRB表达变化,并探讨其临床意义。方法采用免疫组化SP法检测正常子宫内膜(正常组)、不典型增生内膜(不典型增生组)及子宫内膜样腺癌内膜(内膜癌组)组织中的PR及其亚型PRA、PRB表达情况。结果不典型增生组和内膜癌组PR阳性表达率明显低于正常组(P均<0.05),内膜癌组PR表达强度低于正常组和典型增生组(P均<0.05)。正常组、不典型增生组、内膜癌组PRA阳性表达率分别为100%、86.7%(13/15)、74.5%(41/55),PRB阳性表达率分别为100%、80%(12/15)和69.1%(38/55),内膜癌组PRA、PRB阳性表达率与正常组和不典型增生组相比均明显降低(P均<0.05)。正常组25例(82.5%)PRA、PRB表达强度相等,不典型增生组和内膜癌组分别为7例(46.7%)、12例(21.8%),内膜癌组明显低于正常组和不典型增生组,P均<0.01。内膜癌组只表达PRA或PRA占优势者24例(43.6%),明显多于正常组的5例(12.5%)和不典型增生组的4例(26.7%),P均<0.05。PRA表达与子宫内膜癌分化程度有关,PRB表达与子宫内膜癌分化程度、淋巴结转移和FIGO分期有关(P均<0.05)。结论子宫内膜癌患者子宫内膜组织中PR、PRA、PRB表达均明显降低。子宫内膜组织PR亚型表达缺失、比例失衡,尤其是PRB表达缺失可能与子宫内膜癌的发生有关。

Objective To study the changes of progesterone receptors A and B expression in endometrial carcinoma,and explore its clinical significance.Methods The expressions of PR,PRA and PRB were determined by immunohistochemical SP method in normal endometrium（normal group）,atypical hyperplasia endometrium（atypical hyperplasia group） and endometrioid adenocarcinoma（endometrial carcinoma group）.Results Significantly lower PR levels were found in endometrial carcinoma group and atypical hyperplasia group compared with normal group（P0.05）.Endometrial carcinoma group had a significantly lower expressional intensity of PR than normal and atypical hyperplasia group（P0.05）.The positive rate of PRA in normal,atypical hyperplasia and endometrial carcinoma group was 100%,86.7%（13/15）,74.5%（41/55）,respectively.The positive rate of PRB in three groups was 100%,80%（12/15）and 69.1%（38/55）,respectively.The positive rates of PRA and PRB were both significantly lower in endometrial carcinoma group than the other two groups（P0.05）.82.5% normal endometrium expressed both of the isoforms at similar levels,which was significantly higher than that in atypical hyperplasia and endometrial carcinoma group（46.7%,21.8%,P0.01）.24 cases（43.6%） in endometrial carcinoma group expressed PRA only or a predominance of PRA,which was significantly higher than that in normal（5 cases,12.5%,P0.05）and atypical hyperplasia group（4 cases,26.7%,P0.05）.In endometrioid adenocarcinoma,both PRA and PRB had a inverse correlation with histological grade（P0.05）.The expression of PRB had relations with lymphatic metastasis and clinical stage（P0.05）.Conclusion Significantly lower levels of PR,PRA and PRB can be found in endometrial carcinoma.Absence and disruption of relative PR isoform expression,especially the absence of PRB,may be involved in the pathogenesis of endometrial carcinoma.