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Objective: Endometrial cancer is a common gynecological malignancies. Endometrial cancer 5-year survival rate was 84%, about 75% of cases are diagnosed at an early cases, but some of the cases, including some early cases, the prognosis is poor, how to choose these high-risk medical records, so as soon as possible to develop treatment plans , has been a clinical research hotspot. Known pathological factors, such as tissue classification, staging, histological grading, etc. are the main factors influencing the prognosis. In recent years, studies have found that some biological indicators and endometrial cancer occurrence, development and prognosis, such as: hormone receptors, oncogenes, tumor suppressor genes and genes associated with metastasis and other indicators of class. However, the lack of a large number of clinical samples of these indicators comprehensive verification, it is difficult as a prognostic and therapeutic assessment instruments used in clinical. Therefore, this study used estrogen receptors (estrogen receptor, ER), progesterone receptor (progesterone receptor, PR), p53, Survivin, Ki-67 biological indicators, the use of immunohistochemical methods, through the analysis of endometrial carcinoma pathological factors and immunohistochemical factors ER, PR, p53, Survivin, Ki-67 the relationship between the overall assessment of the correlation between them to explore the immunohistochemical factors on prognosis value. METHODS: April 2008 to March 2009 at the Fourth Hospital of Hebei Medical University, 124 gynecological ambulatory surgery patients with endometrial carcinoma clinical, pathological and immunohistochemical data from the pathological type, tissue classification, surgical pathology stage, histological grade, myometrial invasion, lymph node metastasis and vascular invasion seven aspects of analysis and immunohistochemical factors ER, PR, p53, Survivin, Ki-67 relationship. The results were statistically analyzed using SPSS12.O. Results: 1 Clinical data summary 1.1 Age average age 53.4 years (28 years old -76 years old), the peak incidence in the 50-59 years, accounting for 53.2%. Age and tissue classification, staging, histological grade were independent (P gt; 0.05). 1.2 Average age at menarche, menstrual 15.58 years old. Admission premenopausal 70 cases (56.5%), 54 cases of postmenopausal women (43.5%). The average age of 49.37 years old menopause, age at menopause and tissue classification, staging, histological grade were independent (P gt; 0.05). 1.3 average fertility pregnancies 2.85 times 2.06 times the average production times, a total of 15 cases (12.1%) did not give birth. Nulliparous patients compared with patients who have given birth Organization classification, pathological stage and histological grade was no significant difference (P gt; 0.05). 1.4 weight, height, BMI (Body Mass Index, BMI) average weight of 65.81kg; average height of 1.59m; mean BMI 25.81, there are 73 cases (58.9%) overweight, ie BMI gt; 25.0. 1.5 Clinical manifestations of 83.0% of patients Clinical symptoms of abnormal vaginal bleeding based. Complications of hypertension in 32 cases (25.8%), diabetes mellitus 10 cases (8.1%), heart disease, 8 cases (6.5%). Average blood glucose 6.53 mmol / L, mean cholesterol 5.90 mmol / L, mean triglyceride 1.46 mmol / L. High blood sugar, high cholesterol, high triglycerides were higher than the average age of patients with blood sugar, blood lipids in patients with normal. 1.6 Measurement of serum CA125118 patients preoperative serum CA125, CA125 average 38.56u/ml, there are 32 cases more than 35u/ml (27.1%). Respectively, 35 u / ml and 20 u / ml as the normal boundaries, preoperative serum CA125 level is higher, the staging, the later (P lt; 0.05), but it has nothing to do with the organization classification (P gt; 0.05). 1.7 surgical methods are 107 cases (86.3%) lines different ranges of total hysterectomy, double oophorectomy and pelvic lymph node dissection, 17 patients (13.7%) did not lymph nodes. 2 Summary ① pathological pathological type: Ⅰ type endometrial cancer 113 cases (91.1%); Ⅱ endometrial carcinoma 11 cases (9.9%). ② Organization Category: endometrial adenocarcinoma 105 cases (84.7%); special histological type of endometrial cancer were 19 cases (15.3%). ③ surgical stage: Ⅰ of 67 cases (54.0%), Ⅱ 33 cases (26.6%), Ⅲ 20 cases (16.1%), Ⅳ stage 4 cases (3.3%). ④ histological grade: 124 cases of endometrial carcinoma, 105 cases of endometrial adenocarcinoma histological grading, including 30 cases of grade Ⅰ (28.6%), Ⅱ grade 67 cases (63.8%), Ⅲ grade 8 cases (7.6%); 19 cases of special histological type unrated. ⑤ myometrial invasion: 124 patients, 23 cases (18.5%) myometrial invasion gt; 1/2, 101 patients (81.5%) myometrial invasion ≤ 1/2 (2 cases are illustrative only and intimal invasion into the myometrium cases also infiltration ≤ 1/2 group). ⑥ lymph node metastases: 124 patients, 17 cases (13.7%) did not lymph node dissection, there are 107 cases (86.3%) had pelvic lymph node dissection, of which 10 cases (9.3%) had lymph node metastasis, 97 cases (90.7%) found no lymph node metastases. ⑦ vascular invasion: 124 patients, 11 cases (8.9%) with vascular invasion, 113 cases (91.1%) found no vascular invasion. 3 immunohistochemical data of all patients were measured ER, PR and p53, which ER-positive 97 cases (78.2%), PR-positive 101 cases (81.5%), p53-positive 83 cases (66.9%); There are 105 cases of measuring Ki- 67, of which 99 were positive (94.3%); There are 97 cases measured Survivin, including positive 93 cases (95.9%). 4 immunohistochemical factors and pathological type, tissue classification, pathologic stage, histologic grade, myometrial invasion, lymph node metastasis and vascular invasion relationship 4.1 ER-positive rate and had positive rates of type Ⅰ endometrial carcinoma of high in type Ⅱ endometrial cancer (P lt; 0.05). PR-positive rate of type Ⅰ endometrial cancer, myometrial invasion ≤ 1/2, no lymph node tissues higher (P lt; 0.05). PR positive rate over type Ⅰ endometrial cancer, pathology early myometrial invasion ≤ 1/2 of the tissues higher (P lt; 0.05). 4.2 p53 positive rate over type Ⅰ endometrial cancer, pathology early myometrial invasion ≤ 1/2 of the tissues lower (P lt; 0.05). p53-positive rate and clinicopathological factors were irrelevant. 4.3 Ki-67 positive rate too early in the pathology, tissue differentiation better (Ⅰ level), depth of myometrial invasion ≤ 1/2 of the tissues lower (P lt; 0.05). Ki-67 positive rate and pathological factors are irrelevant. 4.4 Survivin positive rates over depth of myometrial invasion ≤ 1/2, no vascular invasion of tissues lower (P lt; 0.05). Survivin positive rate has nothing to do with clinicopathological factors. 5 ER, PR, p53, Ki-67, Survivin relationship between ER, PR positive correlation (r = 0.619, P lt; 0.05); PR, Ki-67 was negatively correlated (r = -0.208, P lt; 0.05); p53, Survivin positive correlation (r = 0.270, P lt; 0.05). Other factors had no significant correlation between. Total of 33 patients were ER (-) and / or PR (-). Where ER (-) and / or PR (-), and the expression of Ki-67-positive patients had pathological late, deep myometrial invasion higher proportion (47.1%, 35.3%). ER (-) and / or PR (-), and the expression of p53-positive patients had lymph node metastasis in a higher proportion (50.0%). However, differences among the groups were not statistically significant (P gt; 0.05). Conclusion: a risk factor for endometrial cancer in age, age at menopause and organizational classification, staging, histological grade were independent. Nulliparous patients with poorly differentiated tissues, but tissue classification and pathological staging. Two patients with higher than normal blood CA125 staging late, can be used as prognostic indicator. 3 ER, PR, p53, Ki-67, Survivin these five immunohistochemical factors, ER, PR-positive and had higher positive rate of expression clinicopathological factors better than the ER and PR is more closely associated with clinical pathology; p53, Ki-67, Survivin positive and over-expression of the more positive rates higher clinicopathological factors worse, it had positive rates and clinical pathological factors more closely linked. ER, PR, p53 associated with the pathological type, can be used as guidance pathological type indicators. 4 ER, PR positive correlation; PR, Ki-67 were negatively correlated; p53, Survivin positive correlation. ER, PR, p53, Ki-67 may be a combination of comprehensive immune factors for endometrial cancer prognosis from the guidance.
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