| Objective: To explore the prognostic significance of estrogen receptor(ER), progesterone receptor (PR), p53, Ki-67, Survivin, and theclinicopathologic features in endometrial carcinoma (EC).Methods: Total146patients with EC were given surgical treatment atthe fourth Hospital of Hebei Medical University from April2008to March2009. The prognostic significance were eplored such as ER, PR, p53, Ki-67,Survivin, and clinical data, such as age, preoperative serum CA-125,pathologic type, histologic type, histologic grade, depth of myometrialinvasion, surgical-pathologic stage of the neoplasia, lymph node metastasis,adnexal involvement and lymph vascular space involvement(LVSI) in EC.Statistical analysis were performed using SPSS18.0software. Kaplan-Meiermethod was used to do survival analysis and draw survival curve. Thelog-rank test was used for univariate analysis, and Cox proportional hazardsregression model was used for multivariate analysis. Statistical significancewas considered for P<0.05.Results:1ER and PR expression were observed in146cases. p53, Ki-67, Survivinexpression was observed in141,121and116cases, respectively. ER, PR, p53,Ki-67and Survivin expression were positive in114(78.1%),116(79.5%),82(58.2%),114(94.2%),110(94.8%) cases, respectively. And theoverexpression rates were82(56.2%),77(52.7%),23(16.3%),66(54.5%),45(38.8%), respectively.2Mean age was54.0years (range28~76).117(80.1%) of146cases were lessthan60years, and29(19.9%) were equal or more than60years.3Pathologic data(1)Pathologic type：132(90.4%) of146patients were typeⅠEC, and4 (2.7%) were type Ⅱ EC,10(6.8%) were the other types.(2) Histologic type：132(90.4%) of146patients were endometrioid adenocarcinoma, and14(9.6%)were non-endometrioid adenocarcinoma.(3) Histologic grade:5(3.4%)of the146patients with endometrioid carcinoma were grade Ⅰ,118(80.8%)were grade Ⅱ,9(6.2%) were grade Ⅲ and3(2.1%%) were undifferentiated.11cases with non-endometrial carcinoma weren't classified by histologicgrade.(4) Surgical-pathologic stage:109(74.7%) of the146patients werestage Ⅰ,10(6.8%) were stage Ⅱ,23(15.8%) were stage Ⅲ, and4(2.7%) werestage Ⅳ.(5)Myometrial invasion:117(80.1%) of the146cases, showedinvasion of less than1/2of the depth myometrium, and29(19.9%) casesshowed equal or more than1/2.(6)Lymph node metastasis: Lymph nodemetastasis was present in12(9.4%) of127cases(19of146cases were notreceived lymphadenectomy).(7)Adnexal involvement: adnexal involvementwas present in19(13.3%) of143cases(3of146cases were not receivedbilateral adnexectomy).(8)LVSI：18(12.3%) of146cases presented LVSI.4Preoperative serum CA-125levelsThe preoperative serum CA-125was tested in130of the146cases. Andthe CA-125level were equal or more than1000U/ml in3cases. The averagelevel was37.99U/ml (range0~416.45) in the other127cases.94(72.3%) ofthe130cases were less than35.00U/ml and36(27.7%) were equal or morethan35.00U/ml.5Survival analysisThe mean follow-up time was39.0months (range7~47), and the mediantime were41months.12(8.2%) of the146cases were died,3(2.1%) caseswere alive with recurrence EC, and131(89.7%) cases were alive with nodiease. One, two and three years overall survival rates were95.9%,93.2%,91.8%, and the disease-free survival rates were93.8%,90.4%,89.7%,respectively.Univariate analysis showed that ER negative, PR negative, p53overexpression, age≥60years, type II, non-endometrioid adenocarcinoma,high-stage, equal or more than1/2depth of myometrial invasion, lymph node metastasis, adnexal involvement and LVSI(+) were prognostic factorsfor poor overall and disease-free survivals (P<0.05). Preoperative serumCA-125≥35.00U/ml was a prognostic factor for poor disease-free survival(P<0.05). Neither Ki-67nor Survivin were shown to be associated withoverall and disease-free survivals (P>0.05).In multivariable analysis, age, surgical-pathologic stage and PR wereindependent prognostic factors for overall survival (RR=5.269,2.293,0.166,P=0.008,0.003,0.011). Myometrial invasion, surgical-pathologic stage andPR was independent prognostic factors for disease-free survival.(RR=3.070,2.551,0.150, P=0.034,0.001,0.001).Conclusion:1Univariate analysis showed that ER and PR negative, p53overexpression,age≥60years, type II, non-endometrioid adenocarcinoma, high-stage, equal ormore than1/2depth of myometrial invasion, lymph node metastasis, adnexalinvolvement and LVSI(+) were prognostic factors for poor overall anddisease-free survivals. Preoperative serum CA-125≥35.00U/ml was aprognostic factor for poor disease-free survival. Neither Ki-67nor Survivinwere shown to be associated with overall and disease-free survivals.2Multivariable analysis showed that age, surgical-pathologic stage and PRwere significant independent prognostic factors for overall survival.Myometrial invasion, surgical-pathologic stage and PR was independentprognostic factors for disease-free survival.3Combinative measurement of ER, PR and p53may be a valuable prognosispredictor for endometrial carcinoma. Especially PR has a close correlationwith the prognosis of endometrial carcinoma. |
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