Expression And Significance Of GLI1 And Shh In The Malignant Transformation Of Ovarian Endometriosis

Objective:By detecting the expression of glioma-associated oncogene homolog 1(GLI1)and sonic hedgehog signaling molecule(Shh)in the Hedgehog signaling pathway during the malignant transformation of ovarian endometriosis,to investigate the expression and clinical significance of GLI1 and Shh in malignant transformation of ovarian endometriosis(EMT).Methods:The expressions of GLI1 and Shh were detected by real-time reverse transcription(RT)-polymerase chain reaction(PCR)and En Vision method in 50 cases of ovarian endometriosis tissues(EMT),35 cases of atypical endometriosis(aEM)and 50cases of endometriosis associated ovarian cancer(EAOC).The aims of this project were to compare the expression differences of two molecular markers in the malignant transformation of endometriosis and to analyze the relationship between the two molecular markers and the clinicopathological features and prognosis of EAOC.Results:QRT-PCR method showed that the expression levels of GLI1 mRNA in EMT,aEM and EAOC group were 1.77±0.40,3.54±0.44,7.80±0.24,respectively.The expression levels of Shh mRNA were 0.95±0.21,3.14±0.35,5.41±0.31,respectively.GLI1 and Shh mRNA in EAOC group were significantly higher than those in EMT and aEM group(P<0.05),and the differences between EMT and aEM group were statistically significant(P<0.05).The percentages of GLI1 in ovarian endometriosis(EMT),atypical endometriosis(aEM)and EAOC were 32%(16/50),57%(20/35)and 66%(33/50),respectively(P<0.05),meanwhile,the positive expression rates of Shh were 20%(10/50),49%(17/35),54%(27/50),respectively(P<0.05).GLI1 mRNA expression was positively correlated with Shh mRNA expression in EAOC tissues(r=0.721,P<0.001).The expressions of GLI1 protein could be proportionated to Shh protein in EAOC tissues(r=0.608,P<0.001).The expression of GLI1 was significantly related to the International Federation of Gynecology and Obstetrics(FIGO)stage,CA125 levels,lymph node metastasis and Platinum resistance in EAOC patience(P<0.05).The expression of Shh was related to FIGO stage and lymph node metastasis in EAOC patience(P<0.05).Logistic regression analysis showed that GLI1 expression was an independent risk factor for poor prognosis in EAOC patients(P<0.05).Kaplan-meier survival analysis showed that the overall survival rate of EAOC patients with high GLI1expression and low GLI1 expression was 6.9%and 26.7%,respectively,with statistical significance(χ~2=10.732,P<0.01).The overall survival rate of patients with high and low expression of Shh protein was 8.3%and 20.0%,the difference was statistically significant(χ~2=3.963,P=0.047).Conclusion:GLI1 and Shh are highly associated with the malignant transformation of endometriosis.They may play a role in promoting malignant degeneration of endometriosis,and the high expression of GLI1 and Shh indicates a poor prognosis in EAOC patients.The high expression of GLI1 protein may be related to platinum resistance in EAOC patients.