Discussion On Molecular Typing Of Endometrial Cancer Using Immunohistochemistry

BackgroundThe Cancer Genome Atlas,TCGA)provides a revolutionary view on the classification of endometrial cancer.According to the characteristics of integrated genome,TCGA classifies endometrial cancer into four different types.However,because of the complexity and high cost of molecular typing,it is not easy to carry out in clinical practice,so it is a hot spot to actively explore a simplified typing method which can be used in clinical practice.Many research groups have studied and published a large number of literatures to explain the detection methods of alternative TCGA molecular typing.In summary,there are two more practical detection methods:The Proactive Molecular Risk Classifier for EC(ProMisE)scheme and Parra-herran scheme.Combining the common points of the two alternative methods,we found that the application of immunohistochemical method to mark MMR protein and P53 protein can roughly distinguish MSI-H type and CN-H type(P53 mutation)endometrial cancer,while the POLE super mutation can not be recognized by immunohistochemical method.However,recently,some studies have found that the tumor infiltrating lymphocytosis is more common in POLE supermutation tumor and MSI-H tumor with better prognosis.After excluding MSI-H type,it should be considered as POLE mutation subtype first.For the evaluation of the number of lymphocytes around the tumor,the method of IMMUNOSCORE(labeled CD3 and CD8)proposed by gal on and his colleagues was used.This method has been proved to be a powerful tool for predicting prognosis in the relevant research of colorectal cancer.The IMMUNOSCORE method has also been used in the study of tumor infiltrating lymphocytes and prognosis of hepatocellular carcinoma and oral squamous cell carcinoma.ObjectiveAccording to the phenomenon of tumor infiltrating lymphocytes and lymphocytosis around tumor in pole mutation group and MSI-H group,we used immunohistochemical method to label MMR,P53,CD3 and CD8 at the same time,and tried to group endometrial cancer.We also analyzed the clinicopathological characteristics between the two groups,to explore whether the simplified molecular typing method of immunohistochemistry can achieve similar prognosis results with molecular typing.MethodBy querying the pathological diagnosis report system,finally,a total of 180 cases were collected,including 146 cases from the pathology department of Zhongda Hospital Southeast University,9 cases from the pathology department of Jiangsu Province Hospital of Chinese medicine,and 25 cases from the pathology department of Nanjing Drum Tower Hospital..Tissue microarray was made and immunohistochemical staining of MMR,P53,CD3 and CD8 were performed at the same time.According to the results of immunohistochemical staining,MMR-IHC,CD3 and CD8 IMMUNOSCORE(I)and P53-IHC were grouped in order.SPSS 20.0 software was used for statistical analysis.Result1.General informationA total of 180 cases were screened out.The maximum age of the patients was 83 years,the minimum age was 28 years,the average age was 56.97 ± 10.86 years,the postoperative follow-up time was 7-72 months,and the median follow-up time was 31.14 months.2.Comparison of morphological groupsThere were differences among the three groups in age,tumor size,scale,stage,uterine serosa involvement,lymph node metastasis,omentum metastasis,myometrial invasion,accessory involvement,vascular invasion,recurrence,metastasis and prognosis.The 1,3,5-year survival rate of high to medium differentiated EEC was significantly higher than that of the other two groups,logrank P<0.05,and the prognosis of low differentiated EEC was better than that of SEC,but there was no significant difference between the two groups.3.Comparison of immunohistochemical groups180 cases were divided into 4 groups.83 cases(46.1%)in MSI-H group,59 cases(32.8%)in tils-h group,13 cases(7.2%)in p53abn group and 25 cases(3.9%)in non characteristic group.There were differences in tumor size,stage,uterine serosa involvement,cervical stroma involvement,omental metastasis,myometrial invasion,vascular invasion and prognosis among the four groups.The prognosis of tils-h group was the best,followed by MSI-H group,but there was no significant difference between the two groups.The prognosis of MSI-H group was better than that of the non characteristic group,the difference between the two groups was significant,and the prognosis of p53abn group was the worst.4 Comparison of two classification methodsIn MSI-H group,the high middle differentiation EEC was the main group;in tils-h group,the high middle differentiation EEC was the main group;in p53 mutation group,the low differentiation EEC was the main group;in non characteristic group,the low differentiation EEC and sec were the main groups.There were 2 cases with MSI-H,tils-h and p53 mutations.There was 1 case with MSI-H and p53 mutation,39 cases with MSI-H and tils-h mutation,and 1 case with tils-h and p53 mutation.Using the nomogram model to compare the cindex.It was found that the pathological tissue group was slightly better than the simplified immunohistochemistry group,but the difference was not statistically significant.Conclusion1.Although the simplified immunohistochemical grouping may not fully reflect the molecular typing of TCGA,but the immunohistochemical grouping has a certain correlation with the prognosis,the morphological differentiation is poor,but the prognosis of TILs-H is good,which has a certain guiding significance for guiding treatment and judging prognosis.2.The simplified method of immunohistochemistry and histopathology are both independent factors that affect the prognosis.There is no statistical difference between the two methods and the prognosis.However,when morphological classification is difficult,the application of immunohistochemistry can improve the accuracy of diagnosis,and guide the prognosis and treatment.