IL-17A和ER蛋白在子宫内膜癌组织中的表达水平及对患者预后的预测价值

Expression and Prognosis Predictive Value of IL-17A and ER Proteins in Endometrial Cancer

【目的】探讨白细胞介素-17A(IL-17A)和雌激素受体(Estrogen receptor,ER)蛋白在子宫内膜癌(EC)组织中的表达水平及对患者预后的预测价值。【方法】选取2013年5月至2016年8月在西安国际医学中心医院均行手术切除的89例EC患者,术后均随访5年。采用免疫组化法检测子宫内膜癌组织、癌旁组织中IL-17A和ER蛋白表达,分析EC患者癌组织中IL-17A和ER蛋白表达水平与临床病理参数的关系及对EC患者预后的影响。【结果】截至随访结束,11例患者失访。癌组织中IL-17A阳性表达率高于癌旁组织(P<0.05),ER阳性表达率低于癌旁组织(P<0.05)。低分化、浸润深度≥1/2、Ⅲ期、合并脉管癌栓EC患者癌组织IL-17A阳性表达率分别高于中高分化、浸润深度<1/2、Ⅰ~Ⅱ期、未合并脉管癌栓者(P<0.05);低分化、浸润深度≥1/2、Ⅲ期、合并脉管癌栓EC患者癌组织ER蛋白阳性表达率分别低于中高分化、浸润深度<1/2、Ⅰ~Ⅱ期、未合并脉管癌栓者(P<0.05)。Cox回归分析显示:分化程度、手术病理分期、脉管癌栓、IL-17A阳性及ER阳性表达是EC患者复发的影响因素(P<0.05);分化程度、手术病理分期、IL-17A阳性及ER阳性表达是总生存率的影响因素(P<0.05)。IL-17A阳性患者无病生存37例,阴性患者无病生存25例,IL-17A阳性表达患者与阴性表达患者的无病生存曲线比较,差异有统计学意义(P<0.05);IL-17A阳性表达患者与阴性表达患者的总存活曲线比较,差异无统计学意义(P>0.05)。ER阳性患者中36例无病生存,阴性患者无病生存26例,ER阳性表达患者与阴性表达患者无病生存曲线比较,差异有统计学意义(P<0.05);ER阳性患者存活39例,阴性患者存活31例,ER阳性表达患者与阴性表达患者的总存活率曲线比较,差异有统计学意义(P<0.05)。【结论】EC患者癌组织中IL-17A和ER蛋白表达与临床病理参数及预后有关,IL-17A阳性、ER阴性者的预后不良风险高。

【Objective】To investigate expression and prognostic significance of interleukin-17A(IL-17A)and Estrogen receptor(ER)proteins in endometrial carcinoma(EC).【Methods】A prospective study was conducted in 89 EC patients admitted to Xi'an International Medical Center Hospital from May 2013 to August 2016.All patients underwent surgical resection and were followed up for 5 years after surgery.Immunohistochemistry was used to detect the expression of IL-17A and ER proteins.The expression of IL-17A and ER protein in cancer tissues and adjacent tissues were compared.The relationship of clinicopathological parameters with expression of IL-17A and ER proteins in EC patients was analyzed.Factors affecting the prognosis of EC patients were analyzed.The relationship between IL-17A and ER protein expression in cancer tissues and survival of EC patients was analyzed as well.【Results】Eleven patients were lost to follow-up by the end of follow-up.The positive expression rate of IL-17A in cancer tissues was higher than adjacent tissues(P<0.05),and the positive expression rate of ER was lower than adjacent tissues(P<0.05).Positive expression rate of IL-17A in cancer tissues of patients with low differentiation,invasion depth≥1/2,stageⅢand vascular cancer thrombus was higher than that of patients with medium and high differentiation,invasion depth<1/2,stageⅠ~Ⅱand no vascular carcinoma thrombus(P<0.05).Positive expression rate of ER protein in cancer tissues of patients with low differentiation,invasion depth≥1/2,stageⅢand complicated with vascular tumor thrombus was lower than that of patients with medium and high differentiation,invasion depth<1/2,stageⅠ~Ⅱand no complicated vascular tumor thrombus(P<0.05).Cox regression analysis showed that the degree of differentiation,surgical pathological stage,vascular tumor thrombus,positive IL-17A and positive ER expression were independent prognostic factors affecting EC recurrence(P<0.05).Tumor differentiation degree,surgical pathological stage,positive IL-17A and positive ER expression were independent prognostic factors affecting the overall survival rate(P<0.05).There were 37 disease-free patients with positive IL-17A and 25 disease-free patients with negative IL-17A;And the difference in disease-free survival curve between patients with positive IL-17A expression and patients with negative IL-17A expression was statistically significant(P<0.05).Forty-four patients with positive IL-17A survived,and 26 patients with negative IL-17A survived.There was no significant difference in the overall survival curve between patients with positive IL-17A expression and patients with negative IL-17A expression(P>0.05).There were 36 disease-free patients in ER positive patients and 26 disease-free patients in ER negative patients.The difference in disease-free survival curves between ER positive and negative patients was statistically significant(P<0.05).There were 39 ER positive patients survived and 31 ER negative patients survived;And the overall survival curve of ER positive and negative patients was statistically significant(P<0.05).【Conclusion】Expression of IL-17A and ER protein in EC patients'cancer tissues is related to clinicopathological parameters and prognosis.Patients with IL-17A positive and ER negative have a high risk of poor prognosis.