子宫内膜样癌患者癌组织中MMR蛋白表达、P53突变、CD3^(+)CD8^(+)免疫评分的临床意义

Clinical significance of mismatch repair gene protein expression,P53 mutation and Cluster of differentiation 3^(+) Cluster of differentiation 8^(+) immune score in cancer tissues of patients with endometrioid carcinoma

目的 探究子宫内膜样癌患者癌组织错配修复基因(MMR)蛋白表达、P53突变、CD3^(+)CD8^(+)免疫评分与临床病理特征及预后的相关性。方法 回顾性收集沧州市中心医院2015年7月至2018年3月收治的120例子宫内膜样癌患者的癌组织切片和临床资料。采取免疫组化法检测癌组织中MMR蛋白表达、P53突变、CD3^(+)CD8^(+)免疫评分,分析其及基于三者的分子分型与患者临床病理特征及预后的关系。结果 120例子宫内膜样癌患者癌组织中MMR蛋白表达缺失40例(33.33%),P53突变47例(39.17%),CD3^(+)CD8^(+)免疫评分I3~I4 86例(71.67%)。癌组织中MMR蛋白表达、P53突变、CD3^(+)CD8^(+)免疫评分与国际妇产科联盟(FIGO)分期、大网膜转移、淋巴结转移有关,且MMR蛋白表达与肌层浸润深度、宫体下段受累有关,P53突变与分化程度、肿瘤最大径、肌层浸润深度有关,CD3^(+)CD8^(+)免疫评分与年龄、分化程度有关(P<0.05)。MMR蛋白表达缺失、P53突变和CD3^(+)CD8^(+)免疫评分I0~I2的子宫内膜样癌患者总生存率、无复发生存率低于MMR蛋白表达未缺失、P53未突变和CD3^(+)CD8^(+)免疫评分I3~I4患者(P<0.05)。年龄、分化程度、肿瘤最大径、FIGO分期、肌层浸润深度、宫体下段受累、淋巴结转移、生存及复发情况在dMMR/MSI-H组、TILs-H组、P53-abn组、无特点组间存在显著差异(P<0.05)。结论 癌组织中MMR蛋白表达、P53突变、CD3^(+)CD8^(+)免疫评分均具有评估子宫内膜样癌患者临床病理特征及预后的价值,基于三者的分子分型可能有助于指导子宫内膜样癌的临床治疗。

Objective To investigate the correlation of mismatch repair gene(MMR)protein expression,P53 mutation,Cluster of differentiation(CD)3+CD8+immune score with clinicopathological characteristics and prognosis of patients with endometrioid carcinoma.Methods The cancer tissue sections and clinical data of 120 patients with endometrioid carcinoma admitted to Cangzhou Central Hospital from July 2015 to March 2018 were retrospectively collected.MMR protein expression,P53 mutation and CD3+CD8+immune score in cancer tissue were detected by immunohistochemistry,and to analyze the relationship between them and the molecular typing based on the three factors and the clinicopathological characteristics with prognosis of patients was analyzed.Results There were 40 patients(33.33%)of MMR protein expression loss in cancer tissues,47 cases(39.17%)of P53 mutation and 86 cases(71.67%)of CD3+CD8+immune score I3-I4 in the cancer tissues of 120 patients with endometrioid carcinoma.MMR protein expression,P53 mutation,CD3+CD8+immune score in cancer tissue were related to international federation of gynecology and obstetrics(FIGO)stage,omentum metastasis and lymph node metastasis,and MMR protein expression was also related to the depth of myometrial invasion and lower uterine involvement,P53 mutation was also related to the degree of differentiation,maximum tumor diameter and depth of myometrial invasion,CD3+CD8+immune score was also related to age and degree of differentiation(P<0.05).The overall survival rate and relapse-free survival rate of endometrial adenocarcinoma patients with MMR loss,P53 mutation and CD3+CD8+immune score I0-I2 in cancer tissues were lower than those of patients without MMR loss and P53 mutation and CD3+CD8+immune score I3-I4(P<0.05).Age,degree of differentiation,maximum tumor diameter,FIGO stage,depth of myometrial invasion,lower uterine involvement,lymph node metastasis,survival and recurrence in dMMR/MSI-H group,TILs-H group,P53-abn group and uncharacteristic group were significantly different(P<0.05).Conclusions MMR protein expression,P53 mutation and CD3+CD8+immune score in cancer tissues are all valuable in evaluating clinicopathological characteristics and prognosis of patients with endometrioid carcinoma,and the molecular typing based on the three may be helpful to guide clinical treatment of endometrioid carcinoma.