子宫内膜癌中TTF-1的表达及临床意义
发布时间：2018-08-04 08:55
【摘要】：【研究背景和目的】子宫内膜癌(endometrial cancer,EC)为子宫内膜上皮来源的恶性肿瘤,是女性生殖道常见的三大恶性肿瘤之一。根据临床、内分泌等特征,子宫内膜癌一般被分为:I型和Ⅱ型两种。在世界范围内,子宫内膜癌的发病率逐渐增加。相关数据表明:2008年后,我国发病率最高的女性生殖系统恶性肿瘤为子宫内膜癌。早期子宫内膜癌,包括FIGO I、Ⅱ期,其5年生存率达到90%以上;然而,FIGOⅢ期、Ⅳ期患者的5年存活率仅仅为57%~66%及20%~26%。相关的基础实验研究进展表明,多种因素影响到子宫内膜癌的发生、进展,包括有不同的癌基因、抑癌基因及转录信号等,其构成的多种信号参与了子宫内膜癌的传导途径。子宫内膜癌给女性健康造成了极重大的影响,同时也增加了经济负担。临床中,主要采取以手术为主的方式治疗子宫内膜癌,必要时再结合一些相关的辅助措施,如放疗、内分泌治疗等,患者预后并不理想。改善子宫内膜癌患者的预后:关键的问题是能否早期发现和早期进行及时有效的治疗?因此,明确子宫内膜癌的病因及发病机制对临床中子宫内膜癌的靶向治疗尤为重要。子宫内膜癌组织中甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)的表达,国内外已有少量的实验研究,但各研究的结论尚不一致,且TTF-1在子宫内膜组织中表达的相关生物学机制仍不清楚。本研究拟采用免疫组织化学方法,检测TTF-1在正常子宫内膜、子宫内膜增生及子宫内膜癌中的表达水平,探讨TTF-1在以上三种不同类型子宫内膜组织中的表达差异,并分析子宫内膜癌中TTF-1的表达与肿瘤临床病理特征之间的关系。【材料和方法】选取大理大学附属医院病理科存档石蜡标本73例,时间在2010年1月~2015年6月之间。其中,正常子宫内膜组织11例、子宫内膜增生17例、子宫内膜癌45例。所有被纳入实验的标本,均通过两位资历较高的病理医师的再次确诊,并符合世界卫生组织的诊断标准。正常子宫内膜作为对照组,实验组包括子宫内膜增生及子宫内膜癌。所有标本均取自术前未经过任何放疗、化疗及手术治疗的患者,但必要的诊断性手术除外。对73例标本进行常规HE染色及免疫组织化学法检测各病例组织中TTF-1的表达,随后结合所选子宫内膜癌标本的相关临床病理信息进行数据整理及分析讨论。【结果】1.基本信息:正常子宫内膜11例,年龄范围25岁至57岁,中位年龄为45岁。子宫内膜增生17例,年龄在36岁到56岁之间,中位年龄是46岁。子宫内膜癌45例,患者的年龄在31岁到78岁之间,中位年龄为56岁。45例子宫内膜癌中,汉族21例、白族14例、其他民族10例;有详细月经史的26例、不清楚的19例。患者的一般临床资料无明显的统计学差异(P0.05),即所选病例符合实验条件。2.临床病理信息:45例子宫内膜癌依据WHO分级标准分为:高分化的为25例,中低分化的为20例。参照2014年FIGO分期标准进行手术分期:Ia期子宫内膜癌有32例、Ib期及Ib期以上的有13例。在45例子宫内膜癌中,肌层浸润深度小于1/2的有35例、肌层浸润深度大于等于1/2的有10例;有脉管转移的2例、无转移的43例。3.免疫组织化学染色结果3.1 TTF-1在不同类型子宫内膜组织中的表达正常子宫内膜组织、子宫内膜增生及子宫内膜癌中TTF-1的阳性率分别为45%(5/11)、35%(6/17)及16%(7/45)。TTF-1在正常子宫内膜与子宫内膜癌中的表达,差异有统计学意义(P=0.030);正常子宫内膜与子宫内膜增生中TTF-1的表达,差异无统计学意义(P=0.701);同时,TTF-1在子宫内膜增生与子宫内膜癌中的表达,差异也无统计学意义(P=0.089)。45例子宫内膜癌中TTF-1的阳性率为16%(7/45),其中I型子宫内膜癌有33例,阳性率18%(6/33);II型子宫内膜癌12例,阳性率为8%(1/12)。比较了I型和II型子宫内膜癌中TTF-1的阳性反应,差异无统计学意义,P=0.655。3.2 TTF-1的表达与子宫内膜癌临床病理特征的关系实验结果表明,TTF-1在高分化子宫内膜癌与中分化子宫内膜癌中的表达,差异有统计学意义(P=0.012)。但子宫内膜癌中TTF-1的表达与患者的年龄(P=0.465)、民族(P=0.826)、手术分期(P=0.180)、浸润肌层的深度(P=0.660)及有无转移(P=0.290)均无相关性。【结论】1.TTF-1在正常子宫内膜组织与子宫内膜癌中的表达,差异有统计学意义,再次提示:TTF-1有可能作为一种相关的生物学因子,参与了子宫内膜癌的发生及进展过程。2.高分化与中分化子宫内膜癌中TTF-1的表达差异有统计学意义,提示:在临床中,TTF-1有可能与子宫内膜癌恶性程度的判断、临床手术分期及预后判断有一定的关系。3.一定比例的子宫内膜癌表达TTF-1,当原发部位不明的肿瘤中出现TTF-1阳性时,临床医师需要鉴别肿瘤是否为子宫内膜癌来源。
[Abstract]:[background and purpose] endometrial cancer (EC) is a malignant tumor of the endometrium epithelium. It is one of the three common malignant tumors in the female genital tract. According to the clinical and endocrine characteristics, endometrial carcinoma is divided into two types: I and type II. In the world, the incidence of endometrial cancer is increasing. Additional data suggest that after 2008, the highest incidence of female genital malignancies in China is endometrial cancer. Early endometrial cancer, including FIGO I, stage II, has a 5 year survival rate of more than 90%; however, the 5 year survival rate of the FIGO III and stage IV patients is only 57% ~66% and 20%~26%. related basic experimental research progress. The factors affect the occurrence and progress of endometrial cancer, including different oncogenes, tumor suppressor genes and transcriptional signals, which constitute a variety of signals involved in the transmission of endometrial cancer. Endometrial cancer has a great impact on women's health and also increased the economic burden. In clinical, mainly by surgery. The treatment of endometrial carcinoma should be combined with some related auxiliary measures, such as radiotherapy, endocrine therapy, and so on. The prognosis of the patients is not ideal. The prognosis of the patients with endometrial cancer is improved: the key problem is whether early detection and early and effective treatment can be carried out. Therefore, the etiology and pathogenesis of endometrial cancer are clear. The target therapy of endometrial carcinoma in the bed is particularly important. The expression of -1 (thyroid transcription factor-1, TTF-1) in endometrial carcinoma has been studied at home and abroad, but the conclusions of each study are not consistent, and the related biological mechanism of TTF-1 in endometrial tissue is still not clear. The expression of TTF-1 in normal endometrium, endometrium hyperplasia and endometrial carcinoma was detected by immunohistochemical method, and the expression of TTF-1 in the three different types of endometrium was investigated. The relationship between the expression of TTF-1 in endometrial carcinoma and the clinicopathological features of the tumor was analyzed. 73 cases of paraffin specimens in the pathology department of the Affiliated Hospital of Dali University were selected, between 11 cases of normal endometrium, 17 cases of endometrial hyperplasia and 45 cases of endometrial carcinoma. All the specimens were confirmed by two senior pathologists and met the health of the world. The diagnostic standard of tissue. Normal endometrium was used as a control group. The experimental group included endometrial hyperplasia and endometrial cancer. All specimens were taken from patients without any radiotherapy, chemotherapy and surgical treatment before operation, except for the necessary diagnostic procedures. 73 specimens were examined by routine HE staining and immunohistochemical staining in each case group. The expression of TTF-1 in the fabric was then combined with the related clinicopathological information of selected endometrium cancer specimens. [results] 1. basic information: 11 cases of normal endometrium, age range from 25 to 57 years, 45 years of age, 17 cases of endometrial hyperplasia, between 36 and 56 years old, the middle age is 46 years old. 45 cases of endometrial carcinoma were aged from 31 to 78 years old, with a median age of 56 years of.45 endometrial carcinoma, 21 Han, 14 and 10 other nationalities, 26 cases with detailed menstrual history and 19 cases that were not clear. The patient's general clinical data had no significant statistical difference (P0.05), that is, the selected cases conformed to the.2. clinicopathological letter of experimental conditions. 45 cases of endometrial carcinoma were divided into 25 cases of high differentiation and 20 cases of middle and low differentiation according to the WHO classification standard. 32 cases of endometrial carcinoma in Ia stage, 13 cases in Ib stage and above Ib stage. In 45 cases of endometrial carcinoma, 35 cases of myometrium infiltration depth is less than 1/2, and the depth of myometrium infiltration is greater than that in 45 cases. There were 10 cases of 1/2, 2 cases with vascular metastasis and 43 cases of non metastatic.3. immunohistochemical staining. 3.1 TTF-1 expressed normal endometrium in different types of endometrium. The positive rate of TTF-1 in endometrium hyperplasia and endometrial carcinoma was 45% (5/11), 35% (6/17) and 16% (7/45).TTF-1 in normal endometrium and children. There was significant difference in the expression of endometrial carcinoma (P=0.030), and there was no significant difference in the expression of TTF-1 in normal endometrium and endometrium hyperplasia (P=0.701); meanwhile, there was no significant difference in the expression of TTF-1 in endometrial hyperplasia and endometrial carcinoma (P=0.089) (P=0.089) the positive rate of TTF-1 in endometrial carcinoma was 16% (7). /45), among them, there were 33 cases of type I endometrial carcinoma, the positive rate was 18% (6/33), and 12 cases of II type endometrial carcinoma, the positive rate was 8% (1/12). The positive reaction of TTF-1 in I and II endometrial carcinoma was compared. The relationship between the expression of P=0.655.3.2 TTF-1 and the clinicopathological features of endometrial carcinoma showed that TTF-1 was in high differentiation. There were significant differences in the expression of endometrial carcinoma and medium differentiated endometrial carcinoma (P=0.012), but there was no correlation between the expression of TTF-1 in endometrial carcinoma and the patient's age (P=0.465), the nationality (P=0.826), the surgical staging (P=0.180), the depth of the infiltrating myometrium (P=0.660) and the metastasis (P=0.290). [Conclusion] 1.TTF-1 is in the normal uterus. The expression of membrane tissue and endometrial carcinoma has a significant difference. Again, it is suggested that TTF-1 may be a related biological factor, involved in the development and progression of endometrial carcinoma, and the difference of TTF-1 expression in.2. highly differentiated and moderately differentiated endometrial carcinoma is of great significance. It is suggested that in clinical, TTF-1 may be associated with the child. The judgment of the malignant degree of endometrial carcinoma, the clinical operation stage and the prognosis have certain relation with the expression of.3. in a certain proportion of endometrial carcinoma. When the TTF-1 is positive in the unidentified tumor, the clinician needs to identify whether the tumor is a source of endometrial cancer.
【学位授予单位】：大理大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
本文编号：2163292
[Abstract]:[background and purpose] endometrial cancer (EC) is a malignant tumor of the endometrium epithelium. It is one of the three common malignant tumors in the female genital tract. According to the clinical and endocrine characteristics, endometrial carcinoma is divided into two types: I and type II. In the world, the incidence of endometrial cancer is increasing. Additional data suggest that after 2008, the highest incidence of female genital malignancies in China is endometrial cancer. Early endometrial cancer, including FIGO I, stage II, has a 5 year survival rate of more than 90%; however, the 5 year survival rate of the FIGO III and stage IV patients is only 57% ~66% and 20%~26%. related basic experimental research progress. The factors affect the occurrence and progress of endometrial cancer, including different oncogenes, tumor suppressor genes and transcriptional signals, which constitute a variety of signals involved in the transmission of endometrial cancer. Endometrial cancer has a great impact on women's health and also increased the economic burden. In clinical, mainly by surgery. The treatment of endometrial carcinoma should be combined with some related auxiliary measures, such as radiotherapy, endocrine therapy, and so on. The prognosis of the patients is not ideal. The prognosis of the patients with endometrial cancer is improved: the key problem is whether early detection and early and effective treatment can be carried out. Therefore, the etiology and pathogenesis of endometrial cancer are clear. The target therapy of endometrial carcinoma in the bed is particularly important. The expression of -1 (thyroid transcription factor-1, TTF-1) in endometrial carcinoma has been studied at home and abroad, but the conclusions of each study are not consistent, and the related biological mechanism of TTF-1 in endometrial tissue is still not clear. The expression of TTF-1 in normal endometrium, endometrium hyperplasia and endometrial carcinoma was detected by immunohistochemical method, and the expression of TTF-1 in the three different types of endometrium was investigated. The relationship between the expression of TTF-1 in endometrial carcinoma and the clinicopathological features of the tumor was analyzed. 73 cases of paraffin specimens in the pathology department of the Affiliated Hospital of Dali University were selected, between 11 cases of normal endometrium, 17 cases of endometrial hyperplasia and 45 cases of endometrial carcinoma. All the specimens were confirmed by two senior pathologists and met the health of the world. The diagnostic standard of tissue. Normal endometrium was used as a control group. The experimental group included endometrial hyperplasia and endometrial cancer. All specimens were taken from patients without any radiotherapy, chemotherapy and surgical treatment before operation, except for the necessary diagnostic procedures. 73 specimens were examined by routine HE staining and immunohistochemical staining in each case group. The expression of TTF-1 in the fabric was then combined with the related clinicopathological information of selected endometrium cancer specimens. [results] 1. basic information: 11 cases of normal endometrium, age range from 25 to 57 years, 45 years of age, 17 cases of endometrial hyperplasia, between 36 and 56 years old, the middle age is 46 years old. 45 cases of endometrial carcinoma were aged from 31 to 78 years old, with a median age of 56 years of.45 endometrial carcinoma, 21 Han, 14 and 10 other nationalities, 26 cases with detailed menstrual history and 19 cases that were not clear. The patient's general clinical data had no significant statistical difference (P0.05), that is, the selected cases conformed to the.2. clinicopathological letter of experimental conditions. 45 cases of endometrial carcinoma were divided into 25 cases of high differentiation and 20 cases of middle and low differentiation according to the WHO classification standard. 32 cases of endometrial carcinoma in Ia stage, 13 cases in Ib stage and above Ib stage. In 45 cases of endometrial carcinoma, 35 cases of myometrium infiltration depth is less than 1/2, and the depth of myometrium infiltration is greater than that in 45 cases. There were 10 cases of 1/2, 2 cases with vascular metastasis and 43 cases of non metastatic.3. immunohistochemical staining. 3.1 TTF-1 expressed normal endometrium in different types of endometrium. The positive rate of TTF-1 in endometrium hyperplasia and endometrial carcinoma was 45% (5/11), 35% (6/17) and 16% (7/45).TTF-1 in normal endometrium and children. There was significant difference in the expression of endometrial carcinoma (P=0.030), and there was no significant difference in the expression of TTF-1 in normal endometrium and endometrium hyperplasia (P=0.701); meanwhile, there was no significant difference in the expression of TTF-1 in endometrial hyperplasia and endometrial carcinoma (P=0.089) (P=0.089) the positive rate of TTF-1 in endometrial carcinoma was 16% (7). /45), among them, there were 33 cases of type I endometrial carcinoma, the positive rate was 18% (6/33), and 12 cases of II type endometrial carcinoma, the positive rate was 8% (1/12). The positive reaction of TTF-1 in I and II endometrial carcinoma was compared. The relationship between the expression of P=0.655.3.2 TTF-1 and the clinicopathological features of endometrial carcinoma showed that TTF-1 was in high differentiation. There were significant differences in the expression of endometrial carcinoma and medium differentiated endometrial carcinoma (P=0.012), but there was no correlation between the expression of TTF-1 in endometrial carcinoma and the patient's age (P=0.465), the nationality (P=0.826), the surgical staging (P=0.180), the depth of the infiltrating myometrium (P=0.660) and the metastasis (P=0.290). [Conclusion] 1.TTF-1 is in the normal uterus. The expression of membrane tissue and endometrial carcinoma has a significant difference. Again, it is suggested that TTF-1 may be a related biological factor, involved in the development and progression of endometrial carcinoma, and the difference of TTF-1 expression in.2. highly differentiated and moderately differentiated endometrial carcinoma is of great significance. It is suggested that in clinical, TTF-1 may be associated with the child. The judgment of the malignant degree of endometrial carcinoma, the clinical operation stage and the prognosis have certain relation with the expression of.3. in a certain proportion of endometrial carcinoma. When the TTF-1 is positive in the unidentified tumor, the clinician needs to identify whether the tumor is a source of endometrial cancer.
【学位授予单位】：大理大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
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