免疫组化联合半定量法检测淋巴脉管间隙浸润在早期子宫内膜癌的预后价值

林颖欣; 张月华; 张淦梅; 房惠琼; 张良运; 李财枝; 胡倩; 庞丹梅

doi:10.16016/j.2097-0927.202112273

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免疫组化联合半定量法检测淋巴脉管间隙浸润在早期子宫内膜癌的预后价值

临床医学 | 更新时间：2026-01-09

- 免疫组化联合半定量法检测淋巴脉管间隙浸润在早期子宫内膜癌的预后价值
- Prognostic value of lymphovascular space invasion evaluated by immunohistochemistry and stratification with a semi-quantitative scoring system for early-stage endometrial cancer
- 陆军军医大学学报 2022年44卷第13期页码：1370-1377
- 作者机构：
  
  1.528000 广东佛山，中山大学附属佛山医院: 乳腺肿瘤内科
  2.528000 广东佛山，中山大学附属佛山医院: 病理科
- 作者简介：
  
  [庞丹梅, E-mail: pdmei@fsyyy.com PANG Danmei, E-mail: pdmei@fsyyy.com
- 基金信息：
  
  佛山市卫生健康局医学科研项目(20200187);佛山市“登峰计划”科研项目(2019D054)
- DOI：10.16016/j.2097-0927.202112273
  中图分类号： R181.32;R446.6;R737.33
- 收稿：2021-12-31，
  
  修回：2022-01-23，
  
  纸质出版：2022-07-15
- 稿件说明：
移动端阅览
林颖欣, 张月华, 张淦梅, 等. 免疫组化联合半定量法检测淋巴脉管间隙浸润在早期子宫内膜癌的预后价值[J]. 陆军军医大学学报, 2022,44(13):1370-1377.

Yingxin LIN, Yuehua ZHANG, Ganmei ZHANG, et al. Prognostic value of lymphovascular space invasion evaluated by immunohistochemistry and stratification with a semi-quantitative scoring system for early-stage endometrial cancer[J]. Journal of Army Medical University, 2022, 44(13): 1370-1377.
林颖欣, 张月华, 张淦梅, 等. 免疫组化联合半定量法检测淋巴脉管间隙浸润在早期子宫内膜癌的预后价值[J]. 陆军军医大学学报, 2022,44(13):1370-1377. DOI： 10.16016/j.2097-0927.202112273.

Yingxin LIN, Yuehua ZHANG, Ganmei ZHANG, et al. Prognostic value of lymphovascular space invasion evaluated by immunohistochemistry and stratification with a semi-quantitative scoring system for early-stage endometrial cancer[J]. Journal of Army Medical University, 2022, 44(13): 1370-1377. DOI： 10.16016/j.2097-0927.202112273.

摘要

目的

探讨应用免疫组化联合半定量法检测淋巴脉管间隙浸润(lymphovascular space invasion，LVSI)在早期子宫内膜癌预后评价中的价值。

方法

回顾性收集2010-2017年在中山大学附属佛山医院妇科住院接受根治性手术的早期(2009 FIGO分期Ⅰ~Ⅱ期)子宫内膜癌患者临床病理资料203例，并调取其手术标本病理玻片，采用免疫组化方法判定LVSI的类型属于淋巴管侵犯(lymphatic vessel invasion，LVI)或血管侵犯(blood vessel invasion，BVI)，再运用半定量分层法判定脉管侵犯程度，从而将所有病例分类归为6组: 局灶LVI、广泛LVI、局灶BVI、广泛BVI、LVI+BVI、LVSI(-)组。采用χ

检验比较各组5年无复发生存率的差异，采用Kaplan-Meier法进行生存分析，采用Cox比例风险模型进行单因素及多因素分析不同LVSI状况和其他临床病理因素对早期子宫内膜癌无复发生存时间的影响。

结果

全组203例患者，局灶LVI、广泛LVI、局灶BVI、广泛BVI、LVI+BVI的比例依次为14.7%、7.8%、4.4%、2.0%、5.9%; 5年无复发生存率依次为56.7%、50.0%、33.3%、25.0%、33.3%，与LVSI(-)组相比差异均有统计学意义(

0.01)；中位无复发生存时间依次为74.3、51.5、34.4、26.1、40.7个月，与LVSI(-)组比较均有统计学差异(

0.01)。单因素分析显示，年龄、肌层浸润深度、LVSI状况、术后放疗与早期EC的无复发生存时间有关(

0.05)。多因素预后分析显示，广泛LVI者(

: 5.832

95%

: 2.463~13.808)较局灶LVI者(

: 3.380

95%

: 1.708~6.688)复发风险高，局灶BVI者(

: 12.536

95%

: 4.692~33.493)、广泛BVI者(

: 11.538

95%

: 2.869~46.399)、LVI+BVI者(

: 10.065

95%

: 4.215~24.032)的复发风险相差不大，均高于广泛LVI者；年龄、分期、LVSI状况、术后放疗、术后化疗是影响早期EC预后的独立预后因素(

0.05)。

结论

应用免疫组化联合半定量评价体系来判定脉管侵犯状况可能有助于预测早期子宫内膜癌患者的复发风险。

Abstract

Objective

To investigate the prognostic value of lymphovascular space invasion (LVSI) evaluated by immunohistochemistry and then stratification with a semi-quantitative scoring system for early-stage endometrial cancer.

Methods

We retrospectively reviewed 203 patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ to Ⅱ endometrial cancer who underwent radical surgery in the gynecology department of our hospital between 2010 and 2017. Their clinicopathological and follow-up data were collected. All available slides from the hysterectomy specimens were examined

and immunohistochemical techniques were used to detect LVSI and determine whether the type of LVSI belonged to lymphatic vessel invasion (LVI) or blood vessel invasion (BVI)

and then the results were stratified with a semi-quantitative scoring system to assess the extent of LVSI. All the patients were classified into 6 groups: focal LVI

substantial LVI

focal BVI

substantial LVI

LVI+BVI

and LVSI (-). We used

Chi

-square test to compare the difference in the 5-year recurrence-free survival rate (RFS) among groups and Kaplan-Meier analysis for survival analysis. Univariate and multivariate analyses was used to analyze the influencing factors for survival

and Cox proportional hazards model was adopted to determine the effects of different LVSI statuses and other clinicopathological factors on RFS of early-stage endometrial cancer.

Results

Among the 203 patients

the proportions of focal LVI

substantial LVI

focal BVI

substantial LVI

LVI+BVI were 14.7%

7.8%

4.4%

2.0% and 5.9%

respectively

and their 5-year RFS was 56.7%

50.0%

33.3%

25.0% and 33.3% respectively

and statistical differences were observed when compared with the LVSI (-) group (

0.01). Their median RFS was 74.3

51.5

34.4

26.1 and 40.7 months

respectively

which were significantly different from that of the LVSI(-) group (

0.01). Univariate analysis showed that age

depth of myometrial invasion

LVSI

status

and adjuvant radiotherapy were closely associated with the RFS (all

0.05). Multivariate analysis indicated that the patients with substantial LVI (

: 5.832

95%

: 2.463~13.808) were more likely to relapse than those with focal LVI (

: 3.380

95%

: 1.708~6.688)

and those with focal BVI (

: 12.536

95%

: 4.692~33.493)

substantial BVI (

: 11.538

95%

: 2.869~46.399) or LVI+BVI (

: 10.065

95%

: 4.215~24.032)

had similiar risk levels of recurrence and a higher risk than patients with substantial LVI; And age

stage

LVSI status

adjuvant radiotherapy

and adjuvant chemotherapy were independent prognostic factors for early-stage endometrial cancer (all

0.05).

Conclusion

LVSI evaluated by immunohistochemistry and then stratified with a semi-quantitative scoring system may help predicting the risk of recurrence in early-stage endometrial cancer.

关键词

Keywords

references

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