表皮生长因子受体在子宫颈鳞状上皮内瘤变和鳞状细胞癌中的表达及临床意义

摘要

Objective To study the expression of epidermal growth factor receptor (EGFR),P16 and Ki-67 in cervical intraepithelial neoplasia(CIN)and cervix cancer, and to explore the role of the EGFR in the carcinogenesis of cervix and the diagnostic value in the diagnosis and grade of the CIN. Methods EGFR,P16 and Ki-67 expression in 20 cases of chronic cervicitis, 25 cases of low grade CIN, 25 cases of high grade CIN and 20 cases of carcinomas were examined by EnVision immunohistochemical technique. Results EGFR was negative in chronic cervicitis or few basal cells were positive. With the aggravation of cervical lesions, EGFR expression on the move and the positive rate increased, the difference was significant(P<0.05).The sensitivity, specificity, PPV and NPV of the EGFR in distinguishing chronic cervicitis from low grade CIN were 12%,100%,100%and 47.6%respectively. No statistically significant differences was observed compares to P16 and Ki-67(P>0.05). The sensitivity, specificity, PPV and NPV of the EGFR in distinguishing low grade CIN from high grade CIN were 64%, 88%,84.2%and 71%respectively. The sensitivity and NPV of EGFR were lower than p16 and ki-67 and the differences were statistically significant(P=0.002; P=0.002; P=0.018; P=0.008).The specificity(88%) and PPV(84.2%) of EGFR were above those of P16 and Ki-67, but there was no statistical significance(P=0.157;P=0.702;P=0.725;P=1.000). There were no significantly differences in the distinguishing chronic cervicitis from low grade CIN or low grade CIN from high grade CIN between EGFR/P16 and EGFR/Ki-67(P>0.05). Conclusion EGFR may be important role in the carcinogenesis of the cervix. The combination valuation of EGFR/P16/Ki-67 may be helpful for diagnosis and grade of CIN.%目的：研究表皮生长因子受体（EGFR）、P16和Ki-67在子宫颈浸润性鳞状细胞癌（SCC）和鳞状上皮内瘤变（CIN）中的表达，探讨 EGFR 在宫颈 SCC 发生中的作用及在 CIN 诊断和分级中的价值。方法采用免疫组化EnVision法检测20例慢性宫颈炎、25例低级别CIN、25例高级别CIN和20例SCC中EGFR、P16和Ki-67的表达情况。结果慢性宫颈炎中EGFR表达阴性或仅少数基底层细胞阳性，随着宫颈病变程度的加重，EGFR在上皮层中的表达上移且阳性率增高。EGFR区分慢性宫颈炎和低级别CIN的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为12%、100%、100%和47.6%，与P16和Ki-67比较差异无显著性（P＞0.05）。EGFR区分低级别CIN和高级别CIN的敏感性、特异性、PPV和NPV分别为64%、88%、84.2%和71%，敏感性和NPV均低于P16和Ki-67，且各组差异有统计学意义（P＝0.002；P＝0.002；P＝0.018；P＝0.008）。特异性（88%）和 PPV（84.2%）均高于 P16和Ki-67，但无统计学意义（P＝0.157；P＝0.702；P＝0.725；P＝1.000）。EGFR/P16联合检测在区分慢性宫颈炎和低级别CIN以及低级别CIN和高级别CIN中的敏感性、特异性、PPV和NPV均无显著性差异（P＞0.05）。结论 EGFR在宫颈SCC的发生、发展中可能起着重要作用，EGFR与P16或Ki-67联合检测对宫颈CIN的诊断和分级有一定帮助。