卵巢高级别子宫内膜样癌虽然少见，但诊断上仍然是一个挑战，并对靶向治疗和遗传咨询具有潜在影响。我们研究了卵巢高级别子宫内膜样癌的临床、组织形态学和免疫组织化学特征，并与输卵管卵巢的高级别浆液性癌的诊断重复性进行比较。从1978年至2010年加拿大阿尔伯塔人群卵巢肿瘤类型队列中收集182例卵巢子宫内膜样癌病例，其中30例被确诊为3级卵巢子宫内膜样癌（依据国际妇产科联合会标准）。以低级别子宫内膜样癌和高级别浆液性癌病例作为对照制作组织芯片，进行10项免疫组织化学染色。提取临床资料，并用Cox回归法进行生存分析。为评估组织学类型在阅片者间的可重复性，随机选择25例3级子宫内膜样癌和25例高级别浆液性癌，让5位病理学家各自阅读同1张代表性苏木精-伊红染色切片，并首先在未知WT1/p53免疫组织化学标记结果时阅片，随后在知晓WT1/p53免疫组织化学结果的前提下重新阅片。单因素分析结果显示，3级子宫内膜样癌患者的生存率显著高于高级别浆液性癌患者[风险比(hazard ratio, HR) =0.34，95%可信区间（confidence interval, CI)=0.16-0.67, P=0.0012],但在调整年龄、分期、治疗和残余肿瘤之后，二者生存率无显著差异（HR=1.01,95%C1=0.43~2.16, P=0.98)。单因素分析显示，3级子宫内膜样癌（N=30)与2级子宫内膜样癌（N=23)患者生存期相似(HR=1.07,95%CI=0.39~3.21,P=0.89)，二者免疫组织化学表型也相同。仅根据组织形态学，观察者间对3级子宫内膜样癌和高级别浆液性癌的诊断符合率为69%，而在辅以WT1/p53免疫组织化学标记之后，诊断符合率显著上升至96%（P<0.0001)。我们的数据支持WT1/p53在鉴别3级子宫内膜样癌和高级别浆液性癌中的诊断价值。然而，3级和2级子宫内膜样癌在免疫表型或临床参数上没有差异，提示它们可以合成一组。

王利群 翻译 刘爱军 审校

美国外科病理学杂志中文版2018年第三期摘要No.4

Am J Surg Pathol 2018;42:534-544

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