在部分子宫内膜样癌的浸润前沿可见微囊状、拉长碎片状（Microcystic，Elongated，and Fragmented，MELF）结构。虽然MELF结构被期望为患者预后的指标，但它的预后意义尚不清楚。本研究对子宫内膜样癌患者中MELF结构的病理学特征和其对预后的影响进行了阐述。我们对479例外科手术切除的子宫内膜样癌病例进行了回顾性分析。427例患者中，45例（11%）低级别子宫内膜样癌病例中可见MELF结构，但在52例高级别子宫内膜样癌中未发现MELF结构。在低级别子宫内膜样腺癌中，MELF结构与肿瘤体积较大、超过50%的肌层浸润、国际妇产科学协会的高级别和高分期、脉管侵犯、淋巴结转移、乳头状结构和粘液性分化相关。然而，生存分析显示，有MELF结构与无MELF结构的患者相比，两者的特定疾病生存期与无复发生存期无明显差异。在调整国际妇产科学协会分期后[特定疾病生存期（危险度，1.47；95%可信区间，0.28~7.67，Ρ=0.64），无复发生存期（危险度，0.98，95%的可信区间，0.32 ~ 2.99，Ρ=0.98），MELF不能作为判断预后的指标。免疫组织化学分析显示，MELF结构表达p16和p21阳性，Ki-67几乎为阴性，表明MELF结构与肿瘤细胞的生长阻滞和细胞衰老有关。我们认为，在低级别子宫内膜样癌中，MELF结构对患者的预后影响小。

　　子宫内膜样腺癌，“微囊状、拉长、碎片状（MELF）”结构，生长阻滞，细胞衰老，预后

 

　　来源：Am J Surg Pathol 2017;41:896–905

　　美国外科病理学杂志中文版2017年第一期全文No.3

　　（方媛 翻译；张丽华 审校）

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