자궁내막암과 비정형 복잡성 자궁내막증식증에서의 E-cadherin과 catenin (α-, β-catenin) 단백의 발현
Expression of E-cadherin and Catenin (α-, β-catenin) in Endometrial Cancer and Atypical Complex Endometrial Hyperplasia
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=목적: 자궁내막암과 전암 병변인 비정형 복잡성 자궁내막증식증 조직에서 E-cadherin 및 α, β-catenin에 대한 면역조직화학 염색을 시행하여 자궁내막암의 임상조직학적 예후인자와의 관련시켜 연관성을 조사하여 종양 행동을 예측하는데 도움이 되고자 하였다. 연구 방법: 6예의 비정형 복잡성 자궁내막 증식증과 44예의 자궁내막양 선암의 조직표본을 대상으로 E-cadherin 및 α- catenin과 β-catenin 면역조직화학 염색을 실시하였고, 자궁내막암의 예후인자와의 연관을 분석하기 위하여 FIGO의 수술적 병기 분류에 따른 자궁내막암의 병기, 병리 조직학적 분화도, 자궁근층 침범정도에 따른 발현정도를 조사하였다.결과: 비정형 복잡성 자궁내막증식증과 자궁내막암 병기에 따라 비교한 결과 E-cadherin에서는 병기에 따라 감소된 발현을 보였고 (비정형 복잡성 자궁내막증식증 0/6, I-II기 17/36 (47.2%), III-IV기 5/8 (62.5%); p=0.050), α-catenin에서도 병기가 진행할수록 이상발현의 정도가 증가하는 소견을 보였다 (비정형 복잡성 자궁내막증식증 0/60, I-II기 10/36 (27.8%), III-IV기 5/8 (62.5%); p=0.035). 또한 자궁근층 침윤여부와 염색상의 발현정도에서는 세 가지 모두 침윤이 있을 때 이상소견이 증가하는 소견을 보였다[E-cadherin; 침윤(-) 2/14 (14.3%), 침윤(+) 20/30 (66.7%); p=0.001, α-catenin; 침윤(-) 1/14 (7.1%), 침윤(+) 14/30 (46.0%); p=0.010, β-catenin; 침윤(-) 2/14 (7.1%), 침윤(+) 19/30 (63.0%); p=0.000]. 병리 조직학적 분화도에 따른 염색양상은 β-catenin이 조직학적 분화도에 따라 이상발현의 증가를 보였다 (Grade 1 6/26 (23.1%), Grade 2 6/10 (60.0%), Grade3 5/8 (62.5%); p=0.039).결론: E-cadherin과 α-catenin, β-catenin 의 발현은 자궁내막암과 전암 병변인 비정형 복잡성 자궁내막증식증에서 임상병기, 자궁근층 침윤, 조직학적 분화도와 연관관계가 있었다. 그러므로 자궁내막암과 복잡성 자궁내막증식증에서 E-cadherin과 α-catenin, β-catenin의 발현이 종양의 예후와 연관이 있을 것으로 추정된다.
Abstract
Objective: To evaluate the correlation of the expression of E-cadherin, α-catenin, β-catenin and the clinicopathological features in endometrial cancer (EC) and atypical complex endometrial hyperplasia (ACEH). Methods: Immunohistochemical (IHC) staining of E-cadherin, α-catenin, β-catenin was performed in tissues of 6 ACEHs, 44 endometrioid ECs. We analyzed the correlation of the expression of IHC staining with the prognostic factors according to tumor stage of ACEH & EC, histopathologic grade, and myometrial invasion. Results: According to tumor stage, reduced E-cadherin expression and abnormal α-catenin expression were observed more frequently in advanced stage (reduced E-cadherin: ACEH 0%, stage I-II 47.2%, stage III-IV 62.5%, p=0.050; abnormal α-catenin: ACEH 0%, stage I-II 27.8%, stage III-IV 62.5%, p=0.035). All of the IHC staining showed no correlation with the depth of myometrial invasion but showed correlation with presence of myometrial invasion (reduced E-cadherin: invasion(-) 14.3%, invasion(+) 66.7%, p =0.001; abnormal α-catenin: invasion(-) 7.1%, invasion (+) 46.0%, p=0.010; abnormal β-catenin: invasion(-) 7.1%, invasion(+) 63.0%, p=0.000). According to histological differentiation only abnormal β-catenin expression shows relationship with histopathologic grade (grade 1:23.1%, grade 2:60%, grade 3:62.5%, p=0.039). Conclusion: Expression of E-cadherin and α-catenin showed significantly more reduced expression in EC than in ACEH, and more reduced expression in advanced stage, myometrial invasion and high histopathologic grade. And α-catenin showed more frequent abnormal expression in advanced stage, myometrial invasion and β-catenin showed more frequent in myometrial invasion, high histopathologic grade significantly. These results suggests that the expression of E-cadherin and α-catenin, β-catenin in EC and ACEH could be related to prognosis of the tumor.
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