子宫内膜癌PCNA表达和雌孕激素受体的研究

摘要

Objective　To investigate the proliferating ability of tumor cells in 74 cases with endometrial carcinoma (EMC), as well as define the correlation between clinical pathology, prognostic features and estrogen receptor (ER), progesterone receptor (PR). Methods　Proliferating cell nucleus antigen (PCNA) and ER/PR content were examined using immunohistochemical assay. Results　PCNA was expressed in both benign hyperplasia and EMC, but positive rate in the latter was significantly higher than that in the former (82.4% vs 30.0%)(P<0.01). EMC well differentiated had lower proliferating index (PI) score than those moderately and poorly differentiated(P<0.001), and the PI score was negatively related to the grade of differentiation(r=-0.52, P<0.01). PI score in early cases (Ⅰ/Ⅱ) was significantly lower than that in advanced ones(Ⅲ/Ⅳ) (P<0.05), and the PI score was positively related to the clinical stages (r=0.55, P<0.01). Positive rates of ER, PR were 66.2% (49/74) and 75.7%(56/74) respectively, expression of PCNA was negatively related with ER and PR（r=-0.42，-0.51，respectively，P<0.05）. Conclusions　EMC cells with poorer differentiation or in more advanced stages have faster proliferating ability and aggressive biological behavior. Expression of PCNA combined with detection of ER/PR not only apts to retrospective study, but also has some prognostic value.%目的:探讨子宫内膜癌(endometrial carcinoma，EMC)增殖活性以及雌、孕激素受体的表达与临床病理特性、预后的关系。方法：采用免疫组织化学方法检测74例子宫内膜癌增殖细胞核抗原(proliferating cell nucleus antigen, PCNA)、雌激素受体(estrogen receptor ，ER)、孕激素受体(progesterone receptor ，PR)含量。结果：PCNA在对照组和EMC中的阳性率分别为30.0%和82.4%, 差异有显著性(P<0.01)；在不同分化程度的EMC中PCNA阳性表达率差异无显著性，但PCNA阳性指数(PI)评分，WD明显低于MD，LD，差异有显著性（P<0.001），且与EMC分化程度呈负相关(r=-0.52，P<0.01)；PCNA PI评分与EMC临床期别之间呈正相关(r=0.55，P<0.01)。EMC中ER，PR阳性例数分别为49例(66.2%)和56例(75.7%)，PCNA表达与ER，PR受体之间呈负相关，r值分别为－0.42（P<0.05）和－0.51(P<0.05)。结论：ER和PR阳性、 PCNA PI评分较低的子宫内膜癌，肿瘤细胞异型性小；反之，表现为侵犯邻近组织、扩散、转移等恶性生物学行为。ER，PR和PCNA表达之间有明显互补性。PCNA表达结合ER，PR检测具有方法简单、组织无需特殊处理等特点，适于对常规病理切片作回顾性研究，对鉴别肿瘤性质、预测预后均有一定实用价值。