摘要
目的:探讨ProMisE分子分型在子宫内膜癌(endometrial cancer,EC)中的应用及临床意义。方法:收集2015年至2022年于上海交通大学医学院附属瑞金医院及复旦大学附属妇产科医院行手术治疗且采用高通量测序技术进行ProMisE分子分型的EC患者86例。回顾性分析4种分子分型患者的临床病理特征、免疫相关分子特征。结果:1)分子病理特征:86例EC患者中位年龄57岁,其中POLE超突变2例(2.33%),MMRd亚型27例(31.40%),NSMP亚型35例(40.70%),p53abn亚型22例(25.58%);86例EC中,子宫内膜样腺癌66例,4种分子分型所占比例分别为:POLE突变亚型3.03%(2/66)、MMRd亚型34.85%(23/66)、NSMP亚型45.45%(30/66)、p53abn亚型16.67%(11/66)。浆液性癌10例,分子分型所占比例分别为:NSMP亚型20%(2/10)、p53abn亚型80%(8/10)。4种分子分型患者的分期、病理类型、子宫内膜样腺癌分级差异均有统计学意义(P<0.05),POLE、MMRd、NSMP亚型更倾向于临床早期(在FIGO I~II期中占比更高)和子宫内膜样癌类型,而p53abn型患者诊断时更多为III~IV期和非内膜样癌。在子宫内膜样癌中,POLE和NSMP亚型主要为高中分化;MMRd和p53abn亚型多为中低分化;2)免疫相关分子学特征:86例EC患者中,共59例患者行细胞程序性死亡配体(programmed death ligand 1,PD-L1)蛋白免疫组化法检测,MMRd亚型患者的PD-L1阳性表达率显著高于POLE超突变型、NSMP亚型、p53abn亚型患者(P<0.05)。结论:EC的4种分子分型的构成比及临床病理特征与文献报道基本一致。与传统的组织学分类相比,EC的ProMisE分子分型在临床应用中更客观、重复性强,对EC患者预后有一定预测作用,未来可探索用作添加辅助治疗的有效手段,为EC患者个体化诊断及治疗提供新策略。
Objective:This study aimed to explore the application and clinical significance of Proactive Molecular Risk Classifier for Endometrial Cancer(ProMisE)molecular classifier of endometrial carcinoma(EC).Methods:Eighty-six EC patients who received surgical treatment and underwent ProMisE in Ruijin Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University and Obstetrics and Gynecology Hospital of Fudan University from 2015 to 2022 were included.Clinicopathological features and immune-related molecular features were retrospectively analyzed.Results:Of all the patients included,the median age was 57 years,among which 2 cases(2.33%)were in POLE-ultramutated subtype,27 cases(31.39%)in MMRd subtype,35 cases(40.70%)in NSMP subtype,and 22 cases(25.58%)in p53 abn subtype;66 cases were diagnosed as endometrioid adenocarcinoma,among which 2 cases(3.03%)were in POLE-ultramutated subtype,23 cases(34.85%)in MMRd subtype,30 cases(45.45%)were NSMP subtype,and 11 cases(16.67%)in p53 abn subtype;10 cases were diagnosed as serous carcinoma,among which 2 cases(20%)were in NSMP subtype,and 8 cases(80%)in p53 abn subtype.There were significant differences in clinical stage,pathological classification and degree of differentiation among patients with different ProMisE molecular subtypes(P<0.05);patients in POLE,MMRd and NSMP subtypes tended to be endometrioid carcinoma and be in early stages(FIGO I–II);patients in p53 abn subtype tended to be advanced stages(stage III–IV);of endometrioid carcinoma patients,POLE and NSMP subtypes tended to be highly or moderately differentiated,while MMRd and p53 abn subtypes tended to be moderately or poorly differentiated.Of all the patients included,59 patients underwent programmed cell death ligand-1(PD-L1)immunohistochemical detection;and the PD-L1 positive rate in MMRd subtype was significantly higher than those in POLE,NSMP and p53 abn subtypes(P<0.05).Conclusion:Proportions of 4 ProMisE molecular subtypes and clinicopathological features of EC patients are consistent with findings in previous studies.Compared with conventional histological classification,ProMisE molecular classifier is more objective and reproducible in predicting the prognosis of EC patients,which has the potential value in instructing adjuvant therapy,so as to provide individualized diagnosis and treatment for EC patients.
作者
孙丽丽
刘格丹
贾楠
冯炜炜
Sun Lili;Liu Gedan;Jia Nan;Feng Weiwei(Department of Obstetrics&Gynecology,Ruijin Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China;Department of Gynecology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China)
出处
《肿瘤预防与治疗》
2022年第5期435-441,共7页
Journal of Cancer Control And Treatment
基金
国家自然科学基金(编号:82172601)
上海市科学技术委员会自然科学基金(编号:20ZR1433700)。
