Recurrence risk factors in stage IA grade 1 endometrial cancer

ObjectivesPatients with early-stage endometrial cancers (EC) with disease recurrences have worse survival outcomes. The purpose of this study was to identify clinical and pathologic factors that predict for all recurrences in stage IA grade 1 (IAG1) EC.MethodsRecords from patients diagnosed with EC were retrospectively reviewed. Baseline characteristics of 222 patients with IAG1 EC who underwent surgical resection were analyzed. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors that predict for recurrence.ResultsSeventeen (7.65%) patients had recurrences. The 3-year cumulative incidence of recurrence were significantly higher for patients with time from biopsy to surgery ≥6 months (54% vs. 8%, p=0.003), simple hysterectomy with ovarian preservation vs. total hysterectomy and bilateral salpingo-oophorectomy (31% vs. 9%, p=0.032), any myometrial invasion vs. no invasion (18% vs. 2%, p=0.004), and tumor size ≥2 cm (15% vs. 2%, p=0.021). On, multivariate analysis, any myometrial invasion, increasing time from biopsy to surgery, and larger tumor size were independent predictors of any recurrence. Patients with recurrences had worse outcomes than those without (5-year overall survival [OS]=60%; 95% confidence interval [CI]=16%–86% vs. 5-year OS=95%; 95% CI=87%–99%, respectively, p=0.003).ConclusionTime from biopsy to surgery, larger tumors, and myometrial invasion are the most important predictors of recurrence. Though the recurrence rates are generally low in IAG1 EC, the survival rate for the patients with recurrences was worse than those without. Identification of additional recurrence risk factors can help select patients who may benefit from adjuvant treatment.     

miRNA302b在子宫内膜癌中的表达及其与临床病理参数的关系

目的:检测miRNA302b在子宫内膜癌组织中的表达,并探讨其表达与临床病理参数之间的关系.方法:利用Real-time PCR方法检测40例子宫内膜癌组织及40例正常子宫内膜组织中miRNA302b的相对表达量,并分析miRNA302b在不同临床病理参数的子宫内膜癌标本中表达的差异性.结果:子宫内膜癌中miRNA302b相对表达量(1.195 5±1.645 91)低于其在正常子宫内膜组织中的相对表达量(2.484 6±2.860 33),其差异具有统计学意义(P=0.016<0.05);无淋巴结转移子宫内膜癌组中miRNA302b相对表达量(0.798 2±1.095 60)低于有淋巴结转移组(3.447 4±2.459 57),其差异具有统计学意义(P=0.046<0.05);临床分期为I期的子宫内膜癌组织中miRNA302b的相对表达量(0.483 5±0.438 12)低于其在II、III、IV期的子宫内膜癌组织中的相对表达量(3.331 7±2.088 17),其差异有统计学意义(P=0.002<0.05);组织分化程度为高分化组miRNA302b相对表达量(0.676 4±0.776 56)低于其在中低分化组的相对表达量(2.159 6±2.329 68),其差异有统计学意义(P=0.036<0.05).但miRNA302b 在子宫内膜癌组织中的表达与浸润深度、远处转移等临床病理参数无明显统计学关系(P>0.05).结论:子宫内膜癌组织中miRNA302b表达低于其在正常子宫内膜组织中的表达,且在不同临床分期、组织学分化程度及有无淋巴转移的子宫内膜癌组织中,miRNA302b的表达存在统计学差异,提示其可能在子宫内膜癌发生、发展中发挥作用.     

miRNA-302d在子宫内膜癌组织中的表达及其与临床病理参数的关系

目的:探讨miRNA-302d在子宫内膜癌组织中的表达及其与临床病理参数的关系。方法:应用Real-time PCR方法检测42例子宫内膜癌组织及42例正常子宫内膜组织中miRNA-302d的相对表达量,并分析miRNA-302d在不同临床病理参数的子宫内膜癌组织中表达的差异性。结果:miRNA-302d在子宫内膜癌组织中的表达水平低于其在正常子宫内膜组织中的表达水平(P=0.020<0.05)。手术分期为Ⅰ期与Ⅱ、Ⅲ、Ⅳ期的子宫内膜癌组织中miRNA-302d的表达存在统计学差异（P=0.034<0.05）;在不同的肌层浸润深度（深度＜1/2肌层、深度≥1/2肌层）的子宫内膜癌组织中miRNA-302d的表达具有统计学差异（P=0.006<0.05）;而miRNA-302d在子宫内膜癌组织中的表达水平与组织学分化程度、淋巴转移及脉管浸润等临床病理参数之间无明显统计学关系（P>0.05）。结论:miRNA-302d在子宫内膜癌组织中的表达明显低于其在正常子宫内膜组织中的表达,并且与不同手术病理分期（Ⅰ、Ⅱ、Ⅲ、Ⅳ期）、肌层浸润深度（深度＜1/2肌层、深度≥1/2肌层）有关;提示其可能在子宫内膜癌组织中发挥抑癌基因的作用。     

Recurrence and survival in surgically treated endometrioid endometrial cancer

Introduction The objective of this study was to evaluate different surgical treatments and radiotherapy on patterns of recurrence and overall survival in patients with endometrioid-type endometrial cancer. Materials and methods The retrospective records of 162 patients with endometrioid endometrial cancer were collected. Patients were surgically treated from 1997 to 2002. Recurrence and survival were analyzed according to patient age, surgical procedure, lymphadenectomy, externalbeam irradiation, brachytherapy, surgical stage, myometrial invasion, and tumor grade. Standard statistical calculations were used. Results Median age was 64 years. Median follow-up was 44 months. Overall, ten patients (5.6%) experienced recurrence and 14 (8.6%) died. With univariate analysis, statistical significance for survival was found for age older than 70 years, tumor grade, myometrial invasion, and stage. Multivariate analysis, however, found only age, stage, and grade to be significant. With univariate analysis, statistical significance for recurrence was found for tumor grade, stage, and external-beam radiotherapy as risk factors. Multivariate analysis found only radiotherapy and brachytherapy to be significant, but in an inverted sense, with brachytherapy having a protective effect. Conclusion Our results suggest that brachytherapy protects against recurrence and that neither a surgical approach nor a lymphadenectomy appear to affect recurrence or survival in patients with surgically treated endometrioid endometrial cancer.     

乳腺癌子宫内膜转移3例临床病理分析

目的 探讨乳腺癌子宫内膜转移的临床病理特征、治疗及预后。方法 回顾性分析3例乳腺癌子宫内膜转移患者的临床资料并结合文献复习。结果 3例乳腺癌子宫内膜转移患者中乳腺浸润性小叶癌2例,浸润性导管癌1例。子宫内膜转移灶直径为3~8 cm,中位直径4.5 cm。镜下见子宫内膜转移灶癌细胞呈圆形或椭圆形,细胞质较丰富,部分癌细胞异型性明显,排列呈管状。束状或索状分布,部分区域见小叶样结构。原发灶、子宫内膜转移灶ER、PR、Ki-67均呈阳性表达,CerbB-2、GCDFP-15、E-cadherin染色呈差异性表达,CK7、P120呈局灶阳性,CK5/6、SMA、CD10和S-100呈阴性。结论 乳腺癌伴子宫内膜转移临床少见,预后较差,生存期较短,确诊主要依靠病理和免疫组化检查,ER、PR、CK5/6、CK7、CerbB-2及GCDFP-15对子宫内膜原发癌与转移癌有一定鉴别作用。     

子宫内膜癌临床和病理变化趋势分析

目的　探讨子宫内膜癌临床和病理变化趋势。方法　回顾性分析 30 6例子宫内膜癌患者的临床病理资料。结果　与 2 0世纪 90年代相比 ,近年来年龄 <6 0岁的子宫内膜癌患者增加显著 (P<0 .0 5 ) ,手术范围有所缩小。结论　子宫内膜癌病理特征相对稳定 ,与 2 0世纪 90年代相比近年来的病人更趋年轻化 ,手术范围有所缩小     

绝经前后子宫内膜癌生存因素分析

目的:探讨绝经前后子宫内膜癌的临床资料及预后相关因素。方法:选取2008年1月至2012年3月在唐山市妇幼保健院诊断为子宫内膜腺癌,并接受了手术方法治疗的患者240例。随访共36个月,至2015年3月,分为绝经前和绝经后两组。绝经前115例,绝经后125例,比较两组患者的临床特征、单因素分析两组影响子宫内膜癌患者的预后相关因素及两组间生存率差异。结果:本研究显示绝经前组和绝经后组子宫内膜癌在腺癌类型、深肌层浸润、宫颈受累、淋巴转移、附件受累、病理分级例数、ER、PR阳性例数,比较两者均差异无显著性(P＞0.05)。两组患者的组织类型、浸润深度、病理分级、附件转移、宫颈受累是影响子宫内膜癌预后的独立因素。绝经前与绝经后患者的3年生存率分别为87%、72%,P＜0.05,有明显统计学意义。结论:绝经前后子宫内膜癌预后差异显著,绝经是预后的独立因素。     

miRNA-302 c在子宫内膜癌组织中的表达及其与临床病理资料的关系

目的：探讨miRNA-302c在子宫内膜癌组织中的表达及其与临床病理资料之间的关系。方法：收集中国医科大学附属盛京医院2012年-2015年子宫内膜癌患者手术标本49例及对照组正常子宫内膜组织39例,应用实时荧光定量PCR（ Real-time PCR）方法检测子宫内膜癌组织及正常子宫内膜组织中miRNA-302c的表达情况,分析miRNA-302c在子宫内膜癌组织中的表达与临床病理资料之间的关系。结果：miRNA-302c在子宫内膜癌组织中的表达水平低于正常子宫内膜组织,其差异具有统计学意义（ P＝0.048,﹤0.05）。miRNA-302c在手术分期为Ⅰ期的子宫内膜癌组织中的表达与其在Ⅱ、Ⅲ、Ⅳ期的表达进行比较,差异有统计学意义（ P＝0.010,﹤0.05）;miRNA-302c在不同组织学分化程度（高、中、低分化）的子宫内膜癌组织中的表达的差异具有统计学差异（P＝0.035,﹤0.05）;有淋巴结转移与无淋巴结转移的子宫内膜癌组织中, miRNA-302c表达水平差异具有统计学意义（ P＝0.008,﹤0.05）;而miRNA-302c在子宫内膜癌组织中的表达情况与其他临床病理资料之间无明显统计学关系。结论：miRNA-302c在子宫内膜癌组织中的表达低于正常子宫内膜组织,其差异具有统计学意义。另外,在不同手术病理分期（Ⅰ、Ⅱ、Ⅲ、Ⅳ期）,不同的组织学分化程度（高、中、低分化）,有、无淋巴结转移的子宫内膜癌组织中,miRNA-302c表达水平具有统计学差异。综上所述,miRNA-302c与子宫内膜癌的发生、手术分期、组织学分化程度,有无淋巴结转移存在一定的相关性。     

铂类化疗敏感型卵巢上皮癌复发的影响因素

背景与目的:卵巢癌患者中对铂类化疗敏感者较耐药者预后好,但是铂类化疗敏感型卵巢上皮癌患者中仍有较高的复发率,从而影响此类患者的预后。本研究旨在总结对铂类化疗敏感型卵巢上皮癌患者的临床特点,探讨影响其复发的因素。方法:回顾性分析和总结1993～1999年中山大学肿瘤防治中心收治的90例临床完全缓解超过6个月以上的对铂类化疗敏感型卵巢上皮癌患者复发的影响因素。复发相关的单因素分析采用χ2检验,多因素分析采用Cox模型。结果:90例卵巢上皮癌患者中出现复发者36例,复发率为40.0%,中位复发时间20个月。复发的部位以盆腔最多,占50.0%(18/36)。90例患者总的3年、5年生存率分别为79.6%、69.5%。36例复发患者3年、5年生存率分别为62.3%、39.6%。单因素分析显示铂类化疗敏感型卵巢上皮癌中FIGO分期早、无新辅助化疗、粘液性癌者复发风险低(P=0.001,P=0.002和P=0.025)。经Cox多因素分析显示仅FIGO分期是肿瘤复发的独立危险因子(RR=1.771,P=0.003)。术后采用CBP和铂类其它组合的方案化疗对铂类化疗敏感型卵巢上皮癌复发的影响差异无显著性,过多疗程的术后化疗并不能减少复发。结论:FIGO分期是影响铂类化疗敏感型卵巢上皮癌复发的显著因素,早期诊断对于降低复发十分重要。     

子宫内膜癌的预后及影响因素

目的探讨子宫内膜癌的预后及其影响因素。方法选取2007年2月至2009年1月手术治疗的93例子宫内膜癌患者的临床资料进行分析,采用Cox回归模型对影响因素进行评估。结果93例子宫内膜癌的3、5年的生存率分别为90.3%和84.9%,中位生存期为59.2个月。Cox回归模型分析显示,年龄≥55岁、病理分期Ⅲ期、组织学分级G3、肌层浸润≥1/2和淋巴结转移为影响子宫内膜癌预后的独立危险因素。结论子宫内膜癌具有较好的治疗效果,对其治疗应当合理评估患者的预后相关因素,实施个体化治疗方案,提高患者生存质量。     

胃癌组织HER-2表达与临床病理因素相关性的探讨

目的:探讨HER-2在胃癌组织中的表达及其与临床病理特征和预后的关系.方法:用免疫组化法检测126例胃癌组织和30例正常胃黏膜组织中HER-2表达,并与病理参数及预后比较分析.结果:胃癌组织HER2表达阳性率为29.4%(37/126),正常胃黏膜组织中无HER-2表达,P<0.05;HER-2表达与病变部位、分化程度、年龄、肿瘤浸润深度、有无远处转移、有无淋巴结转移及预后等密切相关,P<0.05;而与性别、是否侵犯神经及是否侵犯脉管无关,P>0.05.结论:HER2表达与胃癌的生物学行为有一定的相关性,检测胃癌组织中HER2的表达对于胃癌的治疗及预后判断有一定指导意义.     

Accuracy of preoperative endometrial biopsy and intraoperative frozen section in predicting the final pathological diagnosis of endometrial cancer

BackgroundHistotype and grade of endometrial cancer (EC) are prognostic factors of nodal involvement and thus of survival. Preoperative biopsy (PB) and intraoperative frozen section (FS) are usually used to guide surgical staging on which the choice of adjuvant therapy will be based successively.ObjectiveThe aim of this study was to assess the agreement rate between PB and FS with final diagnosis (FD) in a series of surgically resected EC.MaterialsAll patients submitted to hysterectomy for EC or atypical endometrial hyperplasia in the Reggio Emilia Province hospitals from 2007 to 2018 were included. Concordance rate differences in histotype, grading, myoinvasion, risk of recurrence between PB, FS and FD were assessed with Fisher's exact test and Mc Nemar contingency test.ResultsA total of 352 patients were identified. For 345 patients it was possible to compare PB and FD results. FS examination was performed in 201/352 (57%) cases, while for 21/352 (6%) patients only an intraoperative macroscopic evaluation was done; in the remaining women, FS-exam was omitted. In 14/201 (7%) cases the tumor wasn't grossly identifiable and the random FS-sampling wasn't able to find the tumor site.High diagnostic concordance of tumor type between PB and FD was observed: no significant differences were registered in type 1 and type 2-endometrial cancer identification (83%, 73%, p = 0.121). Significant differences (p = 0.005) were observed comparing FS and FD results: 95% of type 1-ECs were correctly diagnosed by FS, while only 76% of type 2-ECs received a correct diagnosis on FS. PB showed a concordance with FD among tumor grading close to 55% whilst concordance achieved 71% grouping low grade (G1-G2) EC. No significant differences in FS and FD concordance rate were observed between tumor grades. Concordance for low grade was significantly higher than for high grade ECs (89% vs 50%, respectively, p value = 0.014).The concordance rate in evaluating the myoinvasion status between FS and FD was 80% (n: 199 patients), reaching 99% after combining the first 2 groups (0–49% vs ≥ 50%). Twenty-two cases underwent only intraoperative macroscopic evaluation of the myoinvasion, with an accuracy of 91%: only in 1 case the invasion of the cervical stroma was not detected (Stage II), and 1 case the patient was overstaged as Ib.Discrepancies were observed in FS capacity to correctly predict the final ESMO risk group in stage I patients: FS resulted particularly reliable in predicting a low-risk (concordance with FD: 91%) while the accuracy sharply decreased for intermediate- and high-risk patients (62% and 40%, respectively).To investigate the usefulness of FS in EC management, we compared patients who underwent FS (FS-group) or not (no–FS–group). Especially for low risk patients, the FS significantly increased the adequacy of surgical treatment from 53% (no–FS–group) to 72% (FS-group) (p = 0.016).ConclusionsFS remains a useful tool to tailor surgery in EC-patients, avoiding secondary surgery to complete staging particularly in patients with AH + AHBA, low and intermediate risk ECs that could benefit from adjuvant therapy.     

存活蛋白在子宫内膜癌中的表达及其在细胞凋亡中的作用

目的:探讨子宫内膜癌中存活蛋白(survivin)的表达及其对细胞凋亡的作用.方法:免疫组织化学法检测survivin在子宫内膜癌组织中的表达,并且应用RNA干扰技术沉默survivin基因,RT-PCR和Western印迹法检测RNA干扰效果,FCM法检测RNA干扰前后细胞凋亡的变化,Western印迹法检测凋亡相关蛋白caspase-3、caspase-8和bcl-2的表达变化.结果:子宫内膜癌组织中survivin蛋白的阳性率显著高于不典型增生和正常内膜组织(P<0.05和P<0.01).RNA干扰有效抑制了survivin mRNA和蛋白的表达(均为P<0.01),并且诱导了细胞凋亡,2个干扰组的细胞凋亡率均显著高于对照组(P<0.01).RNA干扰亦上调了活性caspase-3、caspase-8的表达.结论:survivin基因的异常表达与子宫内膜癌的发生密切相关,抑制其表达可以诱导子宫内膜癌细胞发生凋亡.     

胃癌分子病理学预后因子的研究进展

癌症患者死亡大多是远处转移的结果，绝大多数进展期癌患者并不是死于原发灶，而是转移灶引起的并发症。细胞粘附因子、各种生长因子、基质降解酶和运动因子参与肿瘤转移过程，而这些因子中大多都被认为是预后有关的因素。本文综述了与胃癌预后有关的基因和分子及其临床应用。     

孕激素及其受体拮抗剂治疗子宫内膜癌

子宫内膜癌是起源于子宫内膜的恶性肿瘤,其发病与雌激素长期刺激有关.近年来激素治疗越来越受到人们关注.孕激素和孕激素受体拮抗剂米非司酮均可抑制子宫内膜癌细胞生长,有望成为子宫内膜癌治疗的新的辅助手段.现综述孕激素及米非司酮治疗子宫内膜癌的研究进展.     

非小细胞肺癌组织Rin1表达与临床病理因素相关性分析

目的：探讨Rin1在非小细胞肺癌（NSCLC）组织中的表达及其与肿瘤细胞增殖和迁徙的相关性。方法：选取90例手术切除的NSCLC标本,采用免疫组织化学（SP三步法）检测Rin1在NSCLC中的表达分布水平,并与相应的癌旁组织进行对比分析。采用Ki-67标记指数评估肿瘤细胞的增殖率。结果：90例NSCLC组织中,48（48／90,53．3％）例Rin1表达上调。Rin1的表达与TNM分期和淋巴转移有关,Rin在Ⅲ～Ⅳ期患者中的表达明显高于Ⅰ～Ⅱ期患者（65．1％VS42．6％）,P=0．032;有淋巴结转移的患者明显高于无淋巴结转移的患者（65．9％VS41．3％）,P=0．019。Rin1阳性表达患者生存时间较短,Rin1阳性表达患者生存时间明显低于Rin1阴性表达患者[（31．15±21．69）VS（48．31±29．31）个月],P〈0．05。结论：Rin1在NSCLC组织中的表达明显高于相应正常的肺组织,Rin1的高表达在肿瘤细胞增殖和迁徙中扮演了重要角色,与NSCLC患者生存率下降有关。     

Risk factors for endometrial cancer at different ages

The importance of the major risk factors for endometrial cancer in women of different ages was evaluated with the use of data from a hospital-based case-control study conducted in Milan, Italy, on 283 women with endometrial cancer and 566 age-matched controls. Current weight was related strongly to the risk of endometrial cancer both in younger (premenopausal) and in older women (with risk estimates for the heaviest categories of 20.3 and 7.7, respectively), thus confirming that obesity is the major cause of endometrial cancer in Northern Italy. Endometrial cancer risk appeared to be approximately proportional to the second power of body mass index. Early menarche and nulliparity were associated with an increased risk of endometrial cancer in premenopausal women, the point estimate for nulliparity rising to 35.1 (with lower confidence limit of 10.2) after adjustment for marital status. However, no association with these factors was evident in postmenopausal women. Combination oral contraceptives were used by 2 cases and 19 controls only [relative risk (RR) = 0.2, with 95% confidence interval = 0.1-0.8]. The use of noncontraceptive estrogens was associated with an elevated risk, which was greater in perimenopausal women (RR = 5.1 for greater than 2 yr of use), and decreased progressively with increasing time after menopause. Late menopause was also related to endometrial cancer. However, the risk estimates for late menopause apparently were more elevated in older women (greater than or equal to 65 yr) than in perimenopausal women. Most of the risk factors identified (excluding late menopause) apparently act on one of the later stages of the process of carcinogenesis, because the excess risk drops after cessation of exposure.