V razvitem svetu je med ginekološkimi raki najpogostejši endometrijski karcinom. Zdravljenje izbora je kirurgija, ki jo pri obsežnejši bolezni dopolnjuje radioterapija in vedno pogosteje tudi ...kemoterapija. Obsežnost kirurškega posega je še vedno nedorečena, kar zahteva novejše doktrine. Pojavljajo se novi pristopi v zdravljenju, upoštevati pa moramo tudi specifičnost zdravljenja pri mlajših bolnicah.
Cilj istraživanja: Istražiti prognostički značaj izraženosti estrogenskih i progesteronskih receptora u miometriju bolesnica s endometrijskim karcinomom. Nacrt studije: U periodu od 1. svibnja 2005. ...do 1. svibnja 2015. prikupljeni su podatci bolesnica s karcinomom endometrija koje su histerektomirane u Klinici za tumore KBC sestara milosrdnica u Zagrebu i bolesnica histerektomiranih zbog drugih razloga. Praćena je izraženost estrogenskih i progesteronskih receptora u tumoru i miometriju, dob ispitanica, veličina tumora, histološki tip, histološki gradus, cervikalni prodor, dubina prodora u miometrij, limfovaskularni prodor, zahvaćenost limfnih čvorova i FIGO klinički stadij. Ispitanici i metode: Skupina je brojala 69 bolesnica s endometrijskim karcinomom i 69 zdravih žena. Prosječna dob bolesnica bila je 65,7 ± 10, a zdravih 64,35 ± 8,89 godina. Ukupno vrijeme praćenja bilo je 120 mjeseci, a gledalo se petogodišnje preživljenje. Dobiveni podatci su obrađeni χ2 testom, Fisherovim egzaktnim testom, multifaktorijalna analiza i Kaplan-Meierovovim testom na razini statističke značajnosti P<0,05. Prikazani su tabelarno i grafički. Period preživljenja bolesnica bez bolesti u odnosu na izraženost ER i PR u miometriju i endometrijskom karcinomu analiziran je Log rank testom. Rezultati: Žene s endometrijskim karcinomom imaju prosječno manju izraženost estrogenskih ER (x = 54,85 ± 38,5%) i progesteronskih receptora PR u tumoru endometrija (x = 49,97 ± 41,44%) nego žene bez endometrijskog karcinoma; ER i PR kontrolne (zdrave) skupine; ER (x = 86,52 ± 8,88%) i PR (x = 87,36 ± 8,55%) u endometriju. Žene s prodorom EC u miometrij imaju prosječno manju izraženost ER (x = 71,32 ± 29,87%) i PR u miometriju (x =75,15 ± 31,92%) nego žene bez prodora EC u miometrij; ER (x = 85,48 ± 8,41%) i PR (x = 86,93 ± 9,25%) u miometriju. Vjerojatnost ukupnog petogodišnjeg preživljenja je 76,8%. Skupina bolesnica starijih od 60 ima vjerojatnost preživljenja 73,7%, mlađih od 60 godina 84,6%. Skupina bolesnica s tumorom <30 mm ima vjerojatnost preživljenja 81,6%, a s tumorom >30 mm 68,3%. Skupina bolesnica s Tipom I endometrijskog karcinoma ima vjerojatnost preživljenja 87,1%, a sa seroznim/papilarnim EC (Tip II) 44,1%. Vjerojatnost petogodišnjeg preživljenja za tumorski gradus je: G1 = 95,2%; G2 = 80,4%; G3 = 49,3%. Skupina bolesnica s cervikalnom invazijom ima 57,1% vjerojatnosti preživljenja, a bez 78,4%. Bolesnice s tumorskim prodorom u miometrij <50% imaju vjerojatnost preživljenja 88%, a >50 % vjerojatnost je 58,1%. Vjerojatnost preživljenja s tumorski pozitivnim limfnim čvorovima je 55,6%, a s negativnim 84,4%. Preživljenje bolesnica bez limfovaskularnog prodora je 90,2%, a s prodorom je 54,5%. Skupina s FIGO 1 - 2 ima vjerojatnost preživljenja 81,1%, a FIGO 3 - 4 49,1%. Vjerojatnost preživljenja skupine s endometrijskim karcinomom i negativnim ER u tumoru je 58,9%, pozitivnim ER 86%, negativnim PR 63,5%, a pozitivnim PR 84,2%. Preživljenje s negativnim ER u miometriju je 50%, a pozitivnim ER 80,4%, te negativnim PR 66,7%, a pozitivnim PR 77,4%. Zaključak: Status estrogenskih i progesteronskih receptora u miometriju bolesnica s endometrijskim karcinomom nije stabilan prognostički čimbenik.
Objectives: To conduct research on prognostic significance of estrogen and progesterone receptors expression in myometrium of patients with endometrial cancer. Study Design: Data was collected from patients from the Zagreb Cancer Clinic. The period covered was from 1st May 2005 to 1st May 2015. The following was considered: expression of estrogen and progesterone receptors in tumor and myometrium, age of examinees, tumor size, histological type, histological grade, cervical penetration, penetration depth in myometrium, lymphovascular space invasion, lymph node involvement, and FIGO stage. Participants and Methods: The group comprised of 69 patients with endometrial cancer and 69 healthy women. The mean age of the patients was 65.7 ± 10 and the mean age of the healthy examinees stood at 64.35 ± 8.89 years. The total monitoring period was 120 months and five year survival rate was considered. Data processing used was χ2 test, Fisher's exact test, multi-factor analysis and log-rank test. The level of statistical significance was p <0.05. Results: The women with endometrial cancer had on average a lower expression of estrogen ER (x = 54.85 ± 38.5%) and progesterone receptors PR in endometrial tumor (x = 49.97 ± 41.44%) than the women without endometrial cancer; ER (x = 86.52 ± 8.88%) and PR in endometrium (x = 87.36 ± 8.55%). The five-year survival rate was 76.8%. The survival rate for a group of patients over 60 years old stood at 73.7%, whilst for those under 60 years old it was 84.6%. The group of patients with a tumor <30 mm had a survival rate of 81.6% and for those with a tumor > 30mm it was 68.3%. A group of patients with endometrial cancer type I had a survival rate of 87.1%, while those with a serous / papillary type II EC had a survival rate of 44.1%. The rate of five-year survival for tumor grade was: G1 = 95.2%; G 2 = 80.4%; G3 = 49.3%. The group of patients with cervical invasion had 57.1% survival rate and those without it 78.4%. The patients with tumor penetration in myometrium <50% had a survival rate of 88% and those with > 50% had the survival rate of 58.1%. The survival rate of those with tumor positive lymph nodes was 55.6%, whereas for those tumor negative it was 84.4%. The survival rate of patients with no lymphovascular invasion was 90.2% and in case of the invasion it was 54.5%. The survival rate amongst the group with FIGO stages I to II stood at 81.1% and for the group with FIGO stages III – IV it was 49.1%. The survival rate of the group with endometrial cancer and negative ER in tumor was 58.9%, for those with positive ER it stood at 86%, for those with negative PR it was 63.5%, while for those with positive PR it was 84.2%. The survival rate for those with negative ER in myometrium was 50%, for those with positive ER it was 80.4% and for the women with negative PR it stood at 66.7%, whereas for those with positive PR it was 77.4%. Conclusion: ER and PR status in myometrium of patients with EC is not a stable prognostic factor. Key words: endometrial cancer, estrogen receptors, progesterone receptors, myometrium, survival rate
