CgA与COX-2在Ⅰ型子宫内膜癌中的表达及意义

发布时间：2018-04-15 23:09

本文选题：子宫内膜癌 + 子宫内膜样腺癌　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:子宫内膜癌(Endometrial Carcinoma,EC)是一种上皮性恶性肿瘤,发生于子宫内膜,是女性生殖道三大恶性肿瘤之一[1],其在女性全身的恶性肿瘤中所占的比例为7%,在女性生殖道恶性肿瘤中所占的比例为20%-30%,其中来源于子宫内膜腺体的腺癌是最常见的类型,在经济发达的国家及我国部分经济发达的城市,EC的发病率在妇科恶性肿瘤中的排名已经位居第一,目前其发病率在全球范围内有逐渐上升的趋势[2],目前EC及癌前期病变年轻化趋势明显,未生育女性的发病率较前有所增加,但至今为止,其发病机制仍没有完全明确[3],在目前临床上所有的观点中,较为认同的是“无抵抗雌激素”学说。根据其发病中对于雌激素的依赖与否可以分为两型:雌激素依赖型(Ⅰ型)和非雌激素依赖型(Ⅱ型)两种,雌激素依赖型在EC中占大多数,均为子宫内膜样腺癌,患者相对来说通常比较年轻,而且常伴有肥胖、高血压、糖尿病、不孕或不育及绝经延迟[4]。Ⅱ型的病理形态相对少见,该型内膜癌的特点是多见于老年体瘦妇女,至今为止尚未找到明确的发病原因。环氧合酶-2(Cyclooxygenase-2,COX-2)是一种诱导性转录酶,在正常的生理状况下机体是检测不到的,但高表达于多种恶性肿瘤组织,近期研究发现,COX-2在某些肿瘤的细胞增殖、抗凋亡和血管生成等过程中发挥一定的作用,与肿瘤的发生、发展以及预后密切相关[5]。传统认为,Ⅰ型EC与神经内分泌密切相关,仅有少量的内分泌细胞(Endocrine Cell)存在于正常的子宫内膜中,而在子宫内膜样腺癌组织中却比较多见内分泌细胞,至今为止,仍不能明确这些内分泌细胞出现的意义及其与EC生物学行为的关系。嗜铬粒蛋白A(Chromogranin A,Cg A)是神经内分泌较特异性的标志物。本研究通过检测COX-2、Cg A在Ⅰ型EC及正常子宫内膜组织中的表达情况,探讨两者在子宫内膜样腺癌的发生、发展中的作用,同时探讨两者在子宫内膜样腺癌的发生、发展过程中的相互关系,评估子宫内膜样腺癌的预后及为指导子宫内膜样腺癌的治疗开拓新的临床路径。方法:1本实验择取2014年5月~2016年8月于河北省人民医院妇科行手术治疗的EC患者52例,其术后送检切除的子宫,病理结果均是子宫内膜样腺癌,将子宫内膜样腺癌的标本作为实验组。选取同期因子宫或卵巢的良性病变给予全子宫切除的患者22例作为对照组,并且其术后病理结果回报为正常子宫内膜。2采用免疫组化法(SP法)检测52例子宫内膜样腺癌及22例正常子宫内膜的石蜡切片中的COX-2、Cg A的表达情况。3分析COX-2、Cg A蛋白的表达与子宫内膜样腺癌各临床病理特征之间的关系。4采用SPSS17.0统计学软件进行统计学分析及处理,P0.05具有统计学意义。5 Spearman相关检验分析二者在子宫内膜样腺癌组织中表达的关系。结果:1 COX-2在正常的子宫内膜组织中的阳性表达率为36.36%,在子宫内膜样腺癌组织中的阳性表达率为80.77%。子宫内膜样腺癌组的COX-2的表达率较正常子宫内膜组的表达率要高,两组比较差异有统计学意义(P0.01)。COX-2的表达与子宫内膜样腺癌的手术病理分期、肌层浸润的深度、组织分化的程度和淋巴结的转移有关。2 Cg A在正常的子宫内膜组织中的表达率为18.18%,而在子宫内膜样腺癌组织中的表达率则为50.00%。子宫内膜样腺癌组的COX-2的表达率较正常子宫内膜组的表达率要高,经统计学分析,两组比较差异有统计学意义(P0.01)。Cg A在子宫内膜样腺癌中的阳性表达与子宫内膜样腺癌的手术病理分期、组织学分级、浸润的深度、淋巴的转移无明显相关性。3相关性分析:COX-2和Cg A两种蛋白在子宫内膜样腺癌组织中的表达呈正相关(r=0.488 P=0.000)。结论:1 COX-2Ⅰ蛋白在子宫内膜样腺癌中高表达,与子宫内膜样腺癌的手术病理分期、深肌层浸润、组织分化程度低及淋巴结的转移有一定的相关性,与EC的发生发展有一定关系。2 Cg A在子宫内膜样腺癌中呈高表达,与子宫内膜样腺癌的手术病理分期、组织学分级、浸润深度等无明显相关性。3 COX-2和Cg A在子宫内膜样腺癌组织中表达呈正相关,可能在内膜癌发生、发展中有协同作用。
[Abstract]:Objective: endometrial carcinoma (Endometrial, Carcinoma, EC) is a kind of malignant epithelial tumors, occurring in the endometrium, is one of the three malignant tumors of female genital tract [1], and its proportion in all female malignant tumor in 7%, which accounted for in the female genital tract malignant tumor in a ratio of 20%-30% which comes from the endometrial gland carcinoma is the most common type of city, in economically developed countries and some of China's economic development, the incidence of EC in gynecological malignant tumor has been ranked in the first place, at present, its incidence in the world within the scope of [2] is rising gradually, the current EC and cancer precancerous lesion of young trend is obvious, the incidence rate of nulliparous women was increased, but so far, its pathogenesis is still not completely clear [3] in clinic at present all view, more identity is "no resistance to estrogen" According to the theory. Its pathogenesis for estrogen dependent or not can be divided into two types: estrogen dependent (type I) and non estrogen dependent (type II) two, estrogen dependent EC in the majority of all endometrial adenocarcinoma, usually were relatively young, and often obesity, hypertension, diabetes mellitus, pathological sterility or infertility and menopause delayed type II [4]. is relatively rare, characteristics of this type of endometrial cancer is more common in older women thin, so far has yet to find a clear cause. Cyclooxygenase -2 (Cyclooxygenase-2, COX-2) is a kind of induced transcription enzyme in physiology under normal conditions the body is not detected, but highly expressed in a variety of malignant tumors, a recent study found that the proliferation of COX-2 cells in some tumors, play a role in anti apoptosis and angiogenesis, and tumor occurrence, development The exhibition is closely related to the prognosis of [5]. and the traditional view that the type of EC and neuroendocrine closely related, only a small amount of endocrine cells (Endocrine Cell) in normal endometrium, and in endometrial adenocarcinoma tissues but more common endocrine cells are still not clear, so far, these endocrine cells appeared and its significance the relationship with the biological behavior of EC. Chromogranin A (Chromogranin A, Cg A) is a marker of neuroendocrine specific. In this study, by detecting the COX-2 expression of Cg A in type EC and normal endometrial tissues, explore both in the occurrence of endometrial adenocarcinoma, development at the same time to explore their role in the occurrence of endometrial adenocarcinoma, the relationship in the process of development, evaluation of prognosis of endometrioid adenocarcinoma and treatment guidance of endometrioid adenocarcinoma development new clinical pathway. Methods: this experiment selects 1 May 2014 ~2016 year in August in Hebei People's Hospital for the surgical treatment of EC patients with 52 cases, the postoperative examination of hysterectomy, pathological results were endometrioid adenocarcinoma, the endometrial adenocarcinoma specimens as the experimental group. The benign lesions were selected to give a full house factor or ovarian uterus resection of 22 patients as the control group, and the postoperative pathology results of normal endometrium.2 by immunohistochemical method (SP method) to detect paraffin sections of 52 cases of endometrial adenocarcinoma and 22 cases of normal endometrium in COX-2 Cg, the expression of A.3 COX-2.4 analysis, the relationship between Cg the expression of A protein in endometrial adenocarcinoma and the clinicopathologic features by using SPSS17.0 statistical software for statistical analysis and processing, P0.05.5 was statistically significant Spearman correlation analysis of two in endometrioid adenocarcinoma The relationship between the expression of cancer tissues. Results: the positive expression of COX-2 in 1 normal endometrial tissue in the rate of 36.36%, the positive expression in endometrial adenocarcinoma tissues the expression of 80.77%. in endometrial carcinoma group COX-2 compared with normal endometrium group was higher, the comparison between the two groups there were statistically significant differences (P0.01) pathology and the expression of.COX-2 in endometrial adenocarcinoma stage, myometrial invasion depth, the degree of expression of tissue differentiation and lymph node metastasis of.2 Cg A in normal endometrial tissue in the rate of 18.18%, while the expression in endometrioid adenocarcinoma tissues the rate for expression of 50.00%. in endometrial cancer group COX-2 compared with normal endometrium group was higher, statistically, there was significant difference between two groups (P0.01).Cg positive expression of A in endometrioid adenocarcinoma and Surgical pathology in endometrial cancer staging, histological grade, infiltration depth, analysis of correlation between.3 associated lymphoid metastasis: no expression of COX-2 was positively related to Cg and A two proteins in endometrioid adenocarcinoma tissues (r=0.488, P=0.000). Conclusion: 1 COX-2 1 protein highly expressed in endometrial adenocarcinoma, pathology and endometrial cancer staging, deep myometrial invasion, metastasis have differentiated and lymph nodes, there is a relationship between.2 Cg A showed high expression in endometrioid adenocarcinoma and the occurrence and development of EC, pathology and endometrioid adenocarcinoma cancer staging, histological grade, depth of invasion, there was no correlation between.3 COX-2 and Cg A expression in endometrial adenocarcinoma tissue was positively correlated, may occur in endometrial carcinoma, synergistic effect in the development.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

【参考文献】