The Expression Of Ki67,ER And PR In Cellular Leiomyoma And Their Impacts On Prognosis

Objective:By analyzing the expression of Ki67,ER and PR in cellular leiomyoma(CL)and uterine leiomyomas(UL),their impacts on the prognosis of CL and UL can be explored,as well as the risk factors of cellular leiomyoma,providing a basis for the selection of clinical treatment and follow-up.Methods:The data of patients who underwent myomectomy in the First Affiliated Hospital of Nanchang University from January 1,2015 to December 31,2019 were collected.According to the inclusion and exclusion criteria,a total of 112 patients were included as the research objects.Among them,56 cases with CL diagnosed by postoperative pathology were treated as the study group,and 56 cases with UL diagnosed by postoperative pathology were treated as the control group.Clinical data of the included cases were collected,including but not limited to: age,body mass index(BMI),gravidity and parity,family history of uterine fibroids(first-degree relatives),history of hypertension,diabetes,history of cesarean section,preoperative hemoglobin(Hb),fasting blood glucose(BG),blood lipids(TG,TC,LDL-C and HDL-C),serum tumor markers(AFP,CEA,CA125 and CA199),number of fibroids(1 / > 1)),fibroid diameter(the largest fibroid diameter was taken when the number of fibroids was more than 1),surgical indications,surgical methods and immunohistochemical indicators,such as Ki67,ER and PR.All patients were followed up for 3 years in our hospital.The first follow-up B-ultrasound at 3 months after operation showed no residual leiomyoma,and then they were reviewed every 6to 12 months in the outpatient clinic.The expressions of Ki67,ER and PR in CL and UL groups were analyzed and their effects on prognosis were explored.The risk factors of recurrence of cellular leiomyoma were analyzed by univariate and multivariate analysis.Results:1.General data of 112 subjects: according to postoperative pathology,they were divided into CL group(56 cases)and UL group(56 cases).The median age of CL group was 33.5 years old,and that of UL group was 35.0 years old.The age,BMI,gravidity and parity,history of cesarean section,history of hypertension,history of diabetes,family history of uterine fibroids,Hb,BG,TG,TC,LDL-C,HDL-C,AFP,CEA,CA125,CA199,fibroid diameter,fibroid number,surgical indications,surgical methods and recurrence were compared between CL and UL groups.There were significant differences in the family history and recurrence of uterine fibroids between the two groups(P < 0.05),and no significant differences in the rest(P >0.05).2.The expression of Ki67 in CL and UL groups: the expression rate of Ki67 in CL group and UL group was 48.2% and 35.7%,respectively,and the proportion of negative Ki67 expression in the two groups was 51.8% and 64.3%,respectively.There was no significant difference between the two groups(P=0.180).3.Expression of ER in CL and UL groups: The proportions of strong,moderate,weak and negative ER expression in CL and UL groups were 33.9% and 19.6%,30.4%and 44.6%,35.7% and 28.6%,0.0% and 7.1%,respectively.The difference between the two groups was statistically significant(P=0.041).4.PR expression in CL and UL groups: The proportion of strong positive PR expression in CL group and UL group was 51.8% and 46.4%,moderate positive PR expression 14.3% and 17.9%,weak positive PR expression was 33.9% and 26.8%,and negative PR expression was 0.0% and 8.9%.There was no significant difference between the two groups(P=0.119).5.According to the 3-year follow-up,56 CL patients were divided into recurrence group(25 cases)and non-recurrence group(31 cases).The age,BMI,gravidity,history of cesarean section,history of hypertension,history of diabetes,family history of uterine fibroids,Hb,BG,TG,TC,LDL-C,HDL-C,AFP,CEA,CA125,CA199,leiomyoma diameter,leiomyoma number,surgical indications and surgical methods were compared between CL recurrence group and CL non-recurrence group.Significant differences in BMI,history of diabetes,fibroid diameter and fibroid number between the two groups existed(P < 0.05),and there were no significant differences between the other two groups(P > 0.05).6.The expression of Ki67 in CL recurrence group and CL non-recurrence group:the expression rate of Ki67 in CL recurrence group and CL non-recurrence group was68.0% and 38.7%,respectively,and negative Ki67 expression was 32.0% and 61.3%,respectively,and the difference between the two groups was statistically significant(P=0.029).7.ER expression in CL recurrence group and CL non-recurrence group: ER was strongly expressed in 44.0% of recurrent CL patients and 25.8% of non-recurrent CL patients,moderately expressed in 28.0% of recurrent CL patients and 32.3% of non-recurrent CL patients,and weakly expressed in 28.0% of recurrent CL patients and 41.9% of non-recurrent CL patients.There was no significant difference between the two groups(P=0.335).8.PR expression in CL recurrence group and non-recurrence group: The proportion of strong positive PR expression in recurrent CL group and non-recurrent CL group was 68.0% and 38.7%,moderate positive PR expression was 12.0% and16.1%,and weak positive PR expression was 20.0% and 45.2%,respectively.There was no significant difference between the two groups(P=0.068).9.Univariate Logistic regression analysis of CL postoperative recurrence: BMI,leiomyoma diameter,leiomyoma number and Ki67 expression were statistically significant(P < 0.05).Multivariate Logistic regression analysis of CL postoperative recurrence: BMI,leiomyoma diameter and Ki67 expression were independent risk factors for postoperative recurrence of CL(P < 0.05).Conclusions:1.The expression level of ER in cellular leiomyomas is higher than that in uterine leiomyomas,and there is a higher risk of recurrence.2.The recurrence rate of cellular leiomyoma was correlated with BMI,Ki67 expression in leiomyoma tissue and leiomyoma size.