Clinical Significance Of The Expression Of PCNA,Ki67and P27in Endometrial Adenocarcinoma:A Correlational Study

Background and ObjectiveIn female malignancy, the incidence of endometrial cancer is increasing year by year, second only to cervical cancer, colorectal cancer and lung cancer, therefore, early diagnosis and treatment of endometrial cancer are extremely important. Activation of oncogenes, inactivation of tumor suppressor gene and cell cycle abnormalities play important roles in the development of endometrial cancer. Proliferating cell nuclear antigen (PCNA) belongs to the cell cycle regulatory proteins, is closely relates to a variety of cell cycle regulatory factors, and is a reliable marker of proliferative phase. Nuclear associated antigen Ki67which expresses only in the proliferation of the cell nucleus and can reflect the proliferative activity of cell. p27, a cyclin-dependent kinase inhibitor, has a very important role in regulating cell cycle. PCNA, Ki67and p27protein immunoreactivities are detected in different endometrial tissues, especially in the carcinoma tissue with different clinicopathological parameters. The study assesses the correlation between the three factors in endometrial adenocarcinoma, explores the pathogenesis of endometrial cancer from positively or negatively effecting cell cycle progression, and provides theoretical basis for clinical treatment and prevention. Materials and MethodsImmunohistochemical staining (S-P) assay was used to measure the expression of PCNA, Ki67and p27protein in30cases of normal tissues,30cases of atypical hyperplasia endometrial tissues and60cases of endometrial adenocarcinoma tissue.Results1. The PCNA positive expression rate in normal endometrium was33.3%; the PCNA positive expression rate in atypical hyperplasia of the endometrium was70.0%; the PCNA positive expression rate in endometrial adenocarcinoma was86.7%. There was significant difference between normal endometrium group and atypical hyperplasia of the endometrium group (P<0.05); there was significant difference between normal endometrium group and endometrial adenocarcinoma (P<0.05); there was significant difference between atypical hyperplasia of the endometrium group and endometrial adenocarcinoma group (P<0.05).2. The Ki67positive expression rate in normal endometrium was3.3%; the Ki67positive expression rate in atypical hyperplasia of the endometrium was33.3%; the Ki67positive expression rate in endometrial adenocarcinoma was78.3%. There was significant difference between normal endometrium group and atypical hyperplasia of the endometrium group (P<0.05); there was significant difference between normal endometrium group and endometrial adenocarcinoma group (P<0.05); there was significant difference between atypical hyperplasia of the endometrium group and endometrial adenocarcinoma group (P<0.05).3. The p27positive expression rate in normal endometrium was100.0%; the p27positive expression rate in atypical hyperplasia of the endometrium was50.0%; the p27positive expression rate in endometrial adenocarcinoma was33.3%. There was significant difference between normal endometrium group and atypical hyperplasia of the endometrium group (P<0.05); there was significant difference between normal endometrium group and endometrial adenocarcinoma group (P<0.05); there was not significant difference between atypical hyperplasia of the endometrium group and endometrial adenocarcinoma group (P>0.05).4. The positive expression rates of PCNA in stage Ⅰ, Ⅱ and Ⅲ endometrial adenocarcinoma were15/28(53.6%),17/22(77.3%) and10/10(100%), respectively. There were significant differences among the three groups (χ2=8.438,P=0.015); positive expression rates of PCNA in grade1(G1), grade2(G2), and grade3(G3) endometrial adenocarcinoma were12/21(57.1%),16/22(72.7%) and17/17(100%), respectively. There were significant differences among the three groups (χ2=9.299, P=0.010); the positive expression rates of PCNA in myometrial invasion<1/2or≥1/2were23/45(51.1%) and14/15(93.3%), and there was significant difference between the two groups(χ2=8.484, P=0.004); the positive expression rates of PCNA in lymph node metastasis and without lymph node metastasis were18/18(100%) and30/42(71.4%), and there was significant difference between the two groups (χ2=6.429, P=0.011).5. The positive expression rates of Ki67in stage Ⅰ, Ⅱ and Ⅲ endometrial adenocarcinoma were19/28(67.9%),20/22(90.9%) and10/10(100%), respectively. There were significant differences among the three groups (χ2=7.066, P=0.029); positive expressions of Ki67in Gl, G2, and G3endometrial adenocarcinoma were10/21(47.6%),19/22(86.4%) and17/17(100%), respectively. There were significant differences among the three groups (χ2=16.235, P<0.001); the positive expressions of Ki67in myometrial invasion<1/2or≥1/2were24/45(53.3%) and11/15(73.3%), and there was no significant difference between the two groups(χ2=1.851,P=0.174); the positive expressions of Ki67in lymph node metastasis and without lymph node metastasis were17/18(94.4%) and28/42(66.7%), and there was significant difference between the two groups (χ2=5.185, P=0.023).6. The positive expressions rates of p27in stage Ⅰ, Ⅱ and Ⅲ endometrial adenocarcinoma were12/28(42.9%),6/22(27.3%) and1/10(10%), respectively. There were significant differences among the three groups (χ2=3.986, P=0.136); the positive expressions of p27in G1, G2, and G3endometrial adenocarcinoma were13/21(61.9%),4/22(18.2%) and0/17(0%), respectively. There were significant differences among the three groups (χ2=19.493, P<0.001); the positive expressions of p27in myometrial invasion<1/2or≥1/2were21/45(46.7%) and2/15(13.3%), there was significant difference between the two groups (χ2=5.288, P=0.021); the positive expressions of p27in lymph node metastasis and without lymph node metastasis were4/18(22.2%) and19/42(45.2%), but there was no significant difference between the two groups (χ2=2.824, P=0.093).7. In endometrial adenocarcinoma, PCNA positive expression rate was positively correlated with correlated with Ki67positive expression rate (r=0.508, P<0.001); PCNA positive expression rate was negatively correlated with p27positive expression rate (r=-0.451, P<0.001); p27positive expression rate was negatively correlated with Ki67positive expression rate (r=-0.572, P<0.001).Conclusion1. The increase of PCNA expression is consistent with the occurrence and development process of endometrial adenocarcinoma.2. Ki67is related to the development of endometrial adenocarcinoma, and can be used as diagnostic marker of endometrial adenocarcinoma.3. p27deactivation may play an important role in the occurrence and development process of endometrial adenocarcinoma.4. The joint detection of PCNA, Ki67, p27three indicators has important reference value in the diagnosis of endometrial adenocarcinoma.