The Relationship Between Immunohistochemical Expression And Clinicopathologic Features And Prognosis Of Poorly Differentiated Endometrial Carcinoma

BackgroundEndometrial cancer is the second most common malignant tumor of female reproductive system in my country,and the incidence rate is increasing year by year.Endometrial cancer with high degree of differentiation usually recovers well after early operation,while endometrial cancer with low degree of differentiation mostly has poor prognosis.In poorly differentiated endometrial cancer,especially poorly differentiated endometrioid carcinoma and uterine serous carcinoma are easily confused in diagnosis.Compared with poorly differentiated endometrioid carcinoma,uterine serous carcinoma is more malignant,more aggressive,and has a higher recurrence and mortality rate.An effective and accurate classification is needed between the two to judge the prognosis and guide patients in later clinical management.ObjectiveThis study mainly applied immunohistochemical staining techniques to study the expression of ER,PR,PTEN,p53,p16,Ki-67,MMR proteins in poorly differentiated endometrioid carcinoma and serous carcinoma of the uterus.The relationship between chemical expression and clinicopathological characteristics and the significance of diagnosis and prognosis of endometrial cancer provide a basis for clinical diagnosis and treatment.MethodsFrom October 2014 to April 2018,55 cases of endometrial cancer were diagnosed in the post-operative pathology department of the Gynecology Department of Henan Provincial People's Hospital.Including 31 cases of poorly differentiated(grade 3)endometrioid carcinoma,the age of onset ranged from 41-69 years old,24 cases of uterine serous carcinoma,the age of onset ranged from 51-75 years old,and all cases were not undergoing chemotherapy,radiotherapy,hormones before surgery Treatment and immunotherapy.All patients will be followed by outpatient or telephone follow-up.The follow-up deadline is September 30,2019.Re-read the HE slices,select and label representative slices,apply immunohistochemistry for ER,PR,PTEN,p16,p53,Ki-67,MMR protein staining,and count them in grade 3 endometrioid carcinoma With the expression of uterine serous carcinoma.Statistical analysis was performed using SPSS 22.0 software.Quantitative data is expressed as mean±standard deviation,qualitative data is expressed as rate,chi-square test is used for comparison between groups,multivariate correlation analysis is analyzed with binary logistic regression model,and univariate and multifactor Cox proportional hazard regressions are used to evaluate patients' OS.Model analysis.The test level ?=0.05,when P<0.05,the difference is statistically significant.Results1.The study included 55 patients with poorly differentiated endometrial cancer,with an average age of onset of 60.64±7.08 years,including 31 patients with grade 3 endometrioid cancer,with an average age of onset of 58.61±6.80 years,and 24 patients with serous carcinoma of the uterus.The average age of onset was 63.25±6.67 years;the average age of onset differed between the two groups.2.There are statistically significant differences between the two groups of grade 3 endometrioid carcinoma and uterine serous carcinoma in FIGO stage,lymphatic vessel infiltration,and prognosis(P=0.028,P=0.016,P=0.012).Age grouping between the two groups(<60 years or ?60 years),the largest diameter of the tumor(<2cm or ?2cm),the depth of muscular layer infiltration(<1/2 muscular layer or ?1/2 muscular layer),whether the lymph node metastasis There was no statistically significant difference between the distance and the presence or absence of metastasis(P>0.05).3.The difference in expression rates of ER,PR,p16,p53 between the two groups of grade 3 endometrioid carcinoma and uterine serous carcinoma is statistically significant(P=0.002,P=0.003,P=0.011,P=0.001).PTEN,Ki-67 and MMR protein expressions were not statistically significant between the two groups(P>0.05).4.Logistic multivariate analysis of variables with statistical differences between the two groups showed that there was a positive correlation between lymphatic vessel infiltration,ER negative expression,p53 positive expression and uterine serous carcinoma(P=0.023,P=0.035,P=0.018),OR values were 25.608,0.058,0.107,that is,lymphatic vessel invasion,ER negative expression,p53 positive expression are risk factors for uterine serous carcinoma.5.Analyze all immunohistochemical indexes and clinicopathological features,and find that PR positive expression is related to no distant metastasis(P=0.008);p16 positive is related to FIGO stage(P=0.001);ER,p53,PTEN,Ki-67.There was no statistically significant difference between MMR expression and age group,tumor size,depth of muscular invasion,lymph node metastasis,lymphatic vessel invasion,and distant metastasis(P>0.05)6.Univariate Cox regression results show that the difference in OS rate between patients with and without distant metastasis and positive PR is statistically significant(P=0.019,P=0.016);that is,the mortality rate of patients with distant metastasis is significantly higher For those without distant metastasis,the mortality rate of PR-negative patients was significantly higher than that of positive patients.7.Multi-factor Cox regression results show that PR negative is an independent influencing factor(P=0.039),HR=0.092.However,distant metastasis is not an independent factor that affects the death of patients(P>0.05).Conclusion1.The expressions of ER,PR,p16 and p53 have significant differences in grade 3 endometrioid carcinoma and uterine serous carcinoma,which is helpful for the identification of two endometrial carcinomas.2.Uterine serous carcinomas are mostly ER-negative,PR-negative,p16 positive,p53-positive,and uterine serous carcinomas are more likely to have lymphatic vessel infiltration;grade 3 endometrioid carcinomas are mostly ER-positive,PR positive,p16 negative,p53 negative.3.PR is an independent factor that affects the prognosis,and PR-positive endometrial cancer has a low probability of distant metastasis.