子宫内膜癌中雌激素受体免疫组织化学染色结果不同评定标准的对比研究

Correlation between estrogen receptor status and clinicopathologic parameters in endometrial cancer： a comparative study by immunohistochemistry using different scoring systems

目的通过分析子宫内膜癌中雌激素受体（ER）表达状况与临床病理参数的相关性，对三种不同的ER免疫组织化学评分方式进行对比研究。方法免疫组织化学EnVision法检测199例子宫内膜癌（其中Ⅰ型癌160例，Ⅱ型癌39例）石蜡标本中ER的表达状况，分别采用美国临床肿瘤学会／美国病理医师学院（ASCO／CAP）、H-Score和Allredscore标准进行评判，分析各自与临床病理参数的相关性。结果三种评分结果均显示，ER表达状况与子宫内膜癌患者术前CA125水平（P=0．015，P=0．007，P=0．023）、组织学分级（均P〈0．01）、孕激素受体（PR）状况（均P〈0．01）以及Ⅰ型癌p53阳性（P=0．042）等参数具有统计学相关性。仅ASCO／CAP（P=0．027）和H-Score（P=0．035）评定结果显示ER的表达状况与Ⅰ型癌患者年龄具有统计学相关性。仅ASCO／CAP与患者的国际妇产科联盟分期（P=0．005）、脉管内瘤栓（P＝0．002）、淋巴结转移（P=0．021）、肌层浸润深度（P=0．067）和大网膜受累（P=0．067）呈负相关。结论与H-Score和Allredscore相比，ASCO／CAP标准判定的ER表达状况与临床病理参数的相关性更为密切，该方法简便易行，适合在子宫内膜癌的临床病理诊断中推广应用。

Objective To compare the efficiency of three different estrogen receptor （ER） immunostaining scoring systems by analyzing the correlation between ER status and clinicopathologic features for prediction of prognosis of patients with endometrial carcinoma （ EC ）. Methods ER immunostaining （ EnVision method） was performed in 160 type Ⅰ EC and 39 type Ⅱ EC paraffin samples and was scored by ASCO/CAP criterion, H-Score and Allred scoring system. Correlation between ER status and clinicopathologic features was statistically analyzed. Results ASCO/CAP criterion, H-Score and Allred （cutoff point： 4- 8） scoring system showed high concordance in the following aspects. In EC patients, ER status was significantly associated with presurgical CA125 levels （P = 0. 015, P = 0. 007, P = 0. 023 ）, histologic grades （all P 〈 0. 01 ） and PR status （ all P 〈 0.01 ）. In type I EC cohort, ER status was significantly correlated with PR status （P =0. 008, P 〈0. 01, P 〈0.01 ） and p53 status （P =0. 042, P = 0.001, P〈0.01）. As of the predictive value of ER status for type Ⅰ EC patient age, ASCO/CAP （P = 0. 027 ） and H-Score criteria （ P = 0. 035 ） were both superior to Allred score system （ P = 0. 064 ）. Among well-known predictive clinicopathologic parameters, including FIGO stage, lympho-vascular involvement, lymph node metastasis, depth of myometrial invasion and omental involvement, ASCO/CAP scoring offered a better correlation （P =0. 005, P =0. 002, P =0. 021, P =0. 067, and P =0. 067, respectively） than H-Score （P 〉 0. 05） and Allred scoring system （P 〉 0. 05）. Conclusions Compared with H-Score and Allred scoring system, ASCO/CAP criterion is more closely correlated with predictive elinicopathologic parameters. Thereforeit may be used as a simple, highly efficient prognostic indicator for EC patients in routine practice.