Clinicopathological Characteristics And Expression Of Marker Proteins In Uterine Carcinosarcoma

Objective:Uterine carcinosarcoma(UCs),also known as uterine malignant mixed mesodermal tumors(MMMT) is a uterine malignant tumor.Because of the low incidence and poor prognosis of this disease,there exit cognitive Limitations at present. This paper analyzes the clinicopathological characteristics,the expression of EGFR, HER-2,VEGF,and the relationship between them and the prognosis of uterine carcinosarcoma.Methods:34 patients diagnosed with Uterine carcinosarcoma received the initial surgical treatment in our Hospital between August,1998 and August,2008.The clinical data were reviewed including the age at diagnosis,symptoms,the extent of the surgery, postoperative pathology,surgical residual disease,postoperative adjuvant therapy,and so on.To analyzes And the relationship between clinicopathological characteristics and prognosis after the pathological review.34 cases have completed follow-up data.The median follow-up was 19 months(range from 5 to 77 months). Immunohistochemistry were performed to detect the expression of EGFR,HER-2 and VEGF in the uterine carcinosarcoma and analyze relationship between the expression and the prognosis was analyzed.All statistical analyses were performed using the SPSS software.The survival was computed using the Kaplan-Meier method with difference determined by log-rank test.Multivariate analyses were performed with the Cox stepwise regression model.Results:The median age was 63 years(range from 47 to 79 years);28 cases were post-menopausal,accounting for 82.4%(28/34);the most common symptoms was irregular vaginal bleeding,accounting for 64.7%(22/34);lymph-vascular space and neural invasion accounting for 47.1%(16/34),deep myometrial invasion accounting for 50.0%(17/34).28 cases had routine lymph node dissection,of which 6 cases had lymph node metastasis,accounting for 21.4%(6/28).The tumor cell differentiation of the epithelial and mesenchymal component with gradeⅠ,ⅡandⅢwere 50% (17/34),29.4%(10/34),20.6%(7/34%),and 38.2%(13/34),23.5%(8/34),38.2% (13/34) respectively.The 3-year(or 5-years) overall survival(OS) of uterine carcinosarcoma was 65.72%,the average overall survival was 57 months(range from 5 to 77 months).The 3-year(or 5-years) progress-free survival(PFS)was 66.04%.The 3-year OS for pationts with FIGO stgeⅠ,Ⅱ,Ⅲ,andⅣwas 100%,71.4%,45.0% and 0(P=0.0012).In univariate analysis,surgical-pathological staging,LVSI and neural invasion,depth of myometrial invasion,histologic type of epithelial,the cell differentiation of epithelial and mesenchymal were statistical significant,related to prognosis(P＜0.05).In multivariate analysis,the cell differentiation of epithelial component and FIGO stages have statistical significance(P＜0.05),as independent prognostic factors of uterine carcinosarcoma.The positive expression rates of EGFR,HER-2 and VEGF protein for epithelial components of uterine carcinosarcoma were 47.1%,11.8%and 41.2%respectively; for mesenchymal components were 2.9%,0 and 44.1%respectively.The positive expression rates of EGFR,HER-2 and VEGF protein for epithelial and mesenchymal components was not associated with the survival.The expression(integrated score) of EGFR in epithelial and mesenchymal components was not associated with the survival. The expression(integrated score) of VEGF in epithelial and mesenchymal components was related to prognosis(P＜0.05),P=0.0006 and P=0.0003 respectively.There was no correlation among the expression of three indicators,as well as between them and the possible prognostic factors(P＞0.05).In multivariate analysis,FIGO stages, the cell differentiation of epithelial component and the expression(integrated score) of VEGF in mesenchymal components were independent prognostic factors of uterine carcinosarcoma(P=0.039,P=0.003 and P=0.042,respectively).Conclusion:The prognosis of uterine carcinosarcoma may be related to FIGO stage, lymph-vascular and neural invasion,depth of myometrial invasion,the pathological type of epithelial component,tumor cell differentiation,as well as the expression of VEGF.While,FIGO stage,cell differentiation of epithelial component,and the expression(integrated score) of VEGF in mesenchymal components were independent prognostic factors of uterine carcinosarcoma.Early diagnosis,content surgery,and the strengthened adjuvant therapy will improve the prognosis of patients.