COX-2在Ⅰ型子宫内膜癌和癌前病变中的表达及临床意义

The expression and clinical significance of COX-2 in type Ⅰ endometrial carcinomas and precancerous lesions

目的探讨环氧合酶(COX-2)在Ⅰ型子宫内膜癌和癌前病变中的表达及临床意义。方法采用免疫组化法检测COX-2在36例增殖期子宫内膜、98例良性子宫内膜增生、67例子宫内膜上皮内瘤变和81例子宫内膜样腺癌(endometrioid adenocarcinoma,EAC)中的表达,并分析COX-2表达与EAC临床病理学特征的关系。结果COX-2在增殖期子宫内膜、良性子宫内膜增生、子宫内膜上皮内瘤变和EAC中的表达率逐渐升高,分别为8.3%(3/36)、15.3%(15/98)、49.3%(33/67)、76.5%(62/81),差异有统计学意义( 2=87.350,P<0.01)。COX-2在EAC中的表达与肿瘤的临床分期、分化程度、脉管内瘤栓和淋巴结转移或远处转移相关(P<0.05),与患者年龄、肿瘤最大径以及肌层浸润深度无相关性(P>0.05)。COX-2表达在EAC诊断中的敏感度和特异度分别为76.5%和54.9%。结论COX-2不仅参与EAC的早期发生,也与EAC的恶性进展有关,可作为EAC防治的靶标,有助于EAC的诊断和鉴别诊断。

Objective To investigate the expression and clinical significance of COX-2 in type Ⅰ endometrial carcinomas and precancerous lesions. Methods Immunohistochemical assay was performed to detect the COX-2 expression in 36 cases of normal proliferative endometrium(PE), 98 cases of benign hyperplastic endometrium(BHE), 67 cases of endometrioid intraepithelial neoplasia(EIN), and 81 cases of endometrioid adenocarcinoma(EAC). Furthermore, the correlations between the COX-2 expression and the clinicopathological features of patients with EACs were analyzed. Results The COX-2 expression in PE, BHE, EIN and EAC were gradually increased, which were 8.3%(3/36), 15.3%(15/98), 49.3%(33/67) and 76.5%(62/81), respectively(χ~2=87.350, P<0.01). The COX-2 expression in EACs was significantly corelated with clinical stage, histologic differentiation, vascular invasion and metastasis of EACs(P<0.05). There was no correlation between the COX-2 expression and age of patients with EACs, tumor size, or depth of myometrium infiltration(P>0.05). The sensitivity and specificity of COX-2 immunostaining in EAC diagnosis were 76.5% and 54.9%, respectively. Conclusion COX-2 does not take part in the early carcinogenesis of EAC, but is correlated to its malignant progression. COX-2 is a potential target for the prevention and treatment of EAC and is helpful for its diagnosis and differential diagnosis.