Evaluation Of Dual Endometrial And Ovarian Carcinomas Based On Next-generation Sequencing And Clinical Pathology Scores

ObjectiveTo explore the diagnostic and prognostic evaluation of clinical pathology scores combined with second-generation sequencing to patients with synchronous endometrial and ovarian carcinomas(SEOCs)to guide clinically individualized treatment.MethodsTo collect clinical pathology data of 68 patient with SEOCs confirmed by postoperative pathology from January 2010 to May 2017,50 cases of endometrioid endometrial carcinomas from January 2011 to December 2011.Patients with synchronous primary endometrial and ovarian carcinomas were grouped by Scully pathological diagnostic criteria.Based on the diagnostic criteria and relevant clinical research data,a scoring standard was established and the patients were regrouped.One case of SEOCs was sequenced using whole-gene exon sequencing.By comparing with the relevant literature data,the mutated gene that is significantly associated with the risk of morbidity in the endometrial tumors of this patient was identified and prepared for experimental verification of a large number of subsequent samples.Excluding all the serous SEOCs,a retrospective analysis of the remaining 46 SEOCs was performed.The comparative study of clinical characteristics and pathological features among the groups of patients was analyzed using Chi-square test.Overall survival(OS)was calculated using Kaplan-Meier statistics.Results1.According to Scully’s criteria,68 patients with SEOCs were initially divided into three groups:(1)synchronous primary endometrial and ovarian carcinomas(18 cases);(2)Endometrial ccarcinoma ovarian metastasis / Ovarian carcinoma endometrial metastasis(47 cases);(3)Unclear grouped cases(3 cases).2.By quantified scoring analysis,patients with 0-1 were defined as simultaneous primary endometrial and ovarian carcinomas(13 cases).Patients with 3-8 points were defined as endometrial carcinoma with ovarian metastasis / ovarian carcinoma with endometrial metastasis(54 cases),and the remaining one with a score of 2 was undefined.3.Select the score of 2 case for whole-exome sequencing.Analysis of the sequencing results showed that there were almost no common somatic mutations and the same copy number variation(CNVs)in the two sites of the patient.Serous carcinoma components were found in the sequenced case when the endometrium and ovarian specimens were re-derived.4.Based on the sequencing results,patients with a score of 2 were divided into dual primary cancer groups.Compare the survival outcomes of the Scully subgroup and scoring subgroups.There was no significant difference in the prognosis between the Scully criteria for the dual primary cancer group and the metastatic cancer group(P=0.059);the prognosis was significantly different between the two groups(P=0.010).5.46 cases of SEOCs were grouped by Scully’s diagnostic criteria and scoring system to analyze the effect of the two groups of methods on prognosis.After Scully’s standardization,there was no statistical difference in the survival prognosis between the dual primary carcinoma group and the metastatic carcinoma group(P=0.149).The survival prognosis of the dual primary cancer group and the metastatic cancer group after the scoring system was grouped was significantly different(P=0.034).The system can more effectively evaluate the prognosis of SEOCs.Retrospective analysis of 46 cases of SEOCs,scoring system after the classification of dual primary carcinoma group and a single endometrioid endometrial carcinoma group in the FIGO stage,tumor grade,myometrial infiltration depth,lymph node metastasis,other sites of infiltration.The prognosis of the dual primary carcinomas were not significantly different from those of the single early stage endometrial carcinomas(P<0.001),further demonstrating the effectiveness of the scoring system in the evaluation of SEOCs subgroups and prognosis.ConclusionThe combination of clinical pathology scores and second-generation sequencing technology can clarify the classification of SEOCs and can effectively evaluate the prognosis of SEOCs,providing a basis for clinical treatment.