免疫组化参数雌激素受体和孕激素受体的临界值在子宫内膜癌中的预后价值

Prognostic value of critical values of the immunohistochemical parameters estrogen receptor and progesterone receptor in endometrial cancer

摘要:

目的： 确定免疫组化参数雌激素受体（estrogen receptor，ER）和孕激素受体（progesterone receptor，PR）在子宫内膜癌中的临界值，更好地评估ER和PR作为子宫内膜癌预后和预测指标的意义。方法： 纳入473例接受手术治疗的Ⅰ~Ⅲ期子宫内膜癌患者，使用受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）和约登指数确定用于预测子宫内膜癌复发的免疫组化参数ER、PR临界值，使用Cox回归模型分析其与子宫内膜癌预后的相关性。结果： 预测Ⅰ~Ⅲ期子宫内膜癌患者复发ER、PR的最佳临界值分别为45%和33%。单因素分析显示ER（Wald=57.948，P=0.000）及PR（Wald=50.538，P=0.000）是内膜癌复发的危险因素；多因素分析显示ER（Wald=9.076，P=0.003）是内膜癌复发的独立危险因素。结论： 当ER以45%为临界值时和PR以33%为临界值时最适合预测内膜癌的复发。

Abstract:

Objective: To initially determine the critical values of the immunohistochemical parameters estrogen receptor (ER) and progesterone receptor (PR) in endometrial cancer, and to better evaluate the significance of ER and PR as prognostic and predictive indicators of endometrial cancer. Methods: A total of 473 patients with stageⅠ-Ⅲendometrial cancer who underwent surgical treatment were included in this study. The receiver operating characteristic curve (ROC curve) and the Jordan index were used to determine the critical values of the immunohistochemical parameters ER and PR for predicting the recurrence of endometrial cancer. Cox regression model was used to analyze the correlation between the factors and the prognosis of endometrial cancer. Results: The optimal critical values of ER and PR for predicting recurrence of patients with stageⅠ-Ⅲendometrial cancer are 45% and 33%, respectively. Univariate analysis showed that ER (Wald=57.948, P=0.000) and PR (Wald=50.538, P=0.000) were risk factors for endometrial cancer recurrence. Multivariate analysis showed that ER (Wald=9.076, P=0.003) was an independent risk factor for endometrial cancer recurrence. Conclusion: When the critical value of ER and PR was 45% and 33% respectively, it is most suitable for predicting the recurrence of endometrial cancer.