摘要
目的分析并比较FIGO 2023新分期系统纳入分子分型后对子宫内膜癌症(endometrial cancer,EC)分期的影响。方法回顾性分析2023年天津市中心妇产科医院病理科确诊并完成分子分型的332例EC,依据EC新FIGO分期标准进行癌症分期。结果332例EC患者,年龄27~76岁,中位年龄56岁。POLE突变型(POLE mutation,POLEmut)30例,错配修复缺陷型(mismatch repair deficiency,MMRd)80例,无特异分子特征型(no specific molecular profile,NSMP)194例,p53异常型(p53 abnormal,p53abn)28例。4种分子分型EC患者的年龄、手术病理分期、病理类型、淋巴结转移率均有显著差异(P<0.05),而肌层浸润深度与淋巴血管侵犯程度则无明显差别。POLEmut组中包括非侵袭性癌19例(63.33%),侵袭性癌11例(36.67%)。纳入分子分型后,原来Ⅱ期的11名患者的分期全部下调为ⅠAmPOLEmut,则Ⅰ期患者由原来的62.07%增加到100%。p53abn组中非侵袭性癌9例(32.14%),侵袭性癌19例(67.86%)。纳入分子分型后,则原来Ⅰ期中伴肌层浸润的4名患者的分期上调为ⅡCmp53abn,则Ⅱ期患者由原来的34.61%增加到50%。结论当分子分型为p53abn或POLEmut时,会导致肿瘤分期的上调或下调,强调完整分子分型在EC分期中的重要性,有利于精准的预后风险分层并作为辅助治疗决策的参考因素。
Purpose To analyze and compare the impact of incorporating molecular classification into the new FIGO(2023)staging system for endometrial cancer(EC).Methods A retrospective analysis was conducted on 332 cases of EC diagnosed and molecular subtyped by Department of Pathology Tianjin CentralHospital of Gynecology Obstetrics in 2023.All cases were staged according to the FIGO(2023)staging criteria for EC.Results The median age of the 332 EC patients was 56 years(range:27-76 years).Molecular subtypes included30 POLE mutation(POLEmut),80 mismatch repair deficiency(MMRd),194 no specific molecular profile(NSMP),and 28 p53 abnormal(p53abn).Significant differences were observed among the four molecular subtypes regarding age,FIGO stage,pathological type,and lymph node metastasis rate(P<0.05).However,no significant differences were found in the depth of myometrial invasion or lymphovascular space invasion.In the POLEmut group,19 cases(63.33%)were of non-aggressive histological types and 11(36.67%)were aggressive.After incorporating molecular subtyping,all 11 stage II patients were downgraded to stage I AmPOLEmut,increasing the proportion of stage I patients from 62.07%to 100%.In the p53abn group,9 cases(32.14%)were non-aggressive and 19(67.86%)were aggressive.Molecular integration led to the upstaging of 4 stage I patients with myometrial invasion to stage II Cmp53abn,increasing the proportion of stage II patients from 34.61%to 50%.Conclusion Molecular subtypes p53abn and POLEmut are associated with distinct alterations in EC staging,specifically leading to tumor upstaging or downstaging.Our findings underscore the critical importance of comprehensive molecular subtyping in EC staging,as it refines prognostic risk stratification and provides valuable guidance for adjuvant treatment decisions.
作者
李文琪
吴海霞
李汉博
司婧文
张青
申彦
Li Wenqi;Wu Haixia;Li Hanbo;Si Jingwen;Zhang Qing;Shen Yan(Department of Pathology,Tianjin Central Hospital of Gynecology Obstetrics,Tianjin 300100,China)
出处
《临床与实验病理学杂志》
2025年第11期1454-1461,共8页
Chinese Journal of Clinical and Experimental Pathology
基金
天津市卫生健康科研项目(TJWJ2024ZD008)
天津市医学重点学科建设资助(TJYXZDXK-3-029C)。
作者简介
通讯作者:申彦,E-mail:serina_shen@163.com。
