Expression Of HMGA2?Ki-67 In Uterine Adenosarcoma And Its Clinicopathological Analysis

Background and ObjectiveUterine Adenosarcoma is a rare mixed malignant tumor,accounting for about 5%of Uterine sarcoma.It is composed of benign epithelium and sarcomatoid stroma The epithelium is composed mainly of endometrioid cells,and sarcomas are usually derived from low-grade uterine homologous mesenchymal components.The incidence of UA is low,the clinical symptoms are not typical,the specificity of immunohistochemical markers is not high,the histological morphology is complex,and it is easy to miss diagnosis and misdiagnosis.The main treatment was surgical treatment,and there was no uniform standard for auxiliary treatment.Early UA had a good prognosis,accompanied by sarcomas of high grade/heterogenesis of sarcoma,myometrial infiltration,sarcomatous overgrowth and lymph node infiltration,which were associated with poor prognosis of UA.Recently,High Mobility Group A2(HMGA2)DNA was found to be highly expressed in UA through high-throughput sequencing,with an expression rate of 24%-28%.It suggested that HMGA2 might be a useful marker and therapeutic target for UA diagnosis.Ki-67 DNA was also found to be highly expressed in UA.This study retrospectively analyzed the clinicopathological features and follow-up status of UA,detected the expression of HMGA2 and ki-67 in UA,and conducted statistical analysis with the clinicopathological parameters of UA,in order to explore the prognostic factors of UA and the significance of HMGA2 in UA.MethodsTo collect all cases of uterine sarcoma patients admitted to Qilu Hospital of Shandong University,Shandong Provincial Hospital,The second Hospital of Shandong University,Shandong Qianfoshan Hospital,and People's Hospital of Weifang from January 2007 to December 2019.Clinical data of 34 patients with UA were analyzed retrospectively,including its clinical features,pathological characteristics and follow-up conditions.Meanwhile,32 UA specimens were collected to detect the expression level of HMGA2 protein,and 15 normal endometrial specimens were taken as control.The difference of HMGA2 expression level between UA and normal endometrial tissues was analyzed,and the relationship between HMGA2,Ki-67 and UA clinicopathological parameters was analyzed.GraphPad Prism 8.0 statistical analysis software was used to compare the clinical characteristics of patients and the factors affecting the prognosis of patients with adenosarcoma of the uterus.Kaplan-meier survival analysis was performed,and log-rank test was used for univariate survival analysis of prognostic factors for uterine adenosarcoma.Group t test was used for measurement data,Fisher's exact probability test was used for enumeration data,and Pearson correlation analysis was used for bivariate data.P<0.05 was considered statistically significant.Results1.Clinical and pathological characteristics1.1 clinical manifestations:The median age of 34 cases of UA was 47 years,with the largest proportion of patients aged 60-69 years(26.47%).The most common occurrence was in the uterine body,accounting for 82.35%.The clinical manifestations of adenosarcoma of the uterus were not specific,and mainly consisted of irregular vaginal bleeding(61.76%).1.2 pathological results:the tumor size varied,with the largest cut area of 14*6cm.The sarcomas were composed of rhabdomyosarcoma in 5 cases,endometrial stromal sarcoma in 2 cases,and leiomyosarcoma in 1 case.There were 22 cases with myometrial infiltration and 4 cases with sarcomatous overgrowth.Immunohistochemical results showed no specificity,with a positive ki-67 rate of 2%-90%and an average of(38.87 ± 5.17)%.1.3 Treatments:30 patients underwent total hysterectomy,3 underwent hysteroscopic resection of lesions,and 1 underwent transvaginal hysterectomy.Among the total hysterectomy patients,26 patients underwent bilateral adnexectomy,2 patients underwent bilateral salpingectomy,and 2 patients underwent salpingectomy plus ovarian biopsy.21 underwent lymphadenectomy.24 postoperative adjuvant chemotherapy regimens were used,most of which were combined chemotherapy regimens.None of the 34 patients underwent postoperative adjuvant radiotherapy.2.Immunohistochemical resultsThe positive rate of HMGA2 expression in uterine adenosarcoma was 28.13%(9/32),while no positive substance was detected in normal endometrial control group,with statistically significant difference(P=0.0413).The expression rate of HMGA2 in UA patients<20 years old(100%)and ?20 years old(20.69%)was inconsistent,and the difference was statistically significant(P=0.0169).The expression of Ki67 was inconsistent in different sarcoma grades and the presence or absence of SO,and the difference was statistically significant(P=0.0186,P=0.0344).In adenosarcoma with negative and positive HMGA2 expression,the positive rate of ki-67 was different,and the difference was statistically significant(P=0.0347).The positive rate of ki-67 was positively correlated with the expression of HMGA2(r=0.5364,P=0.0057).3.Follow-up and prognostic factorsA total of 12 of the 33 UA patients developed recurrence and/or metastasis,including 9 deaths.The 1-year survival rate was 84.38%.To overall survival and progression-free survival in patients with single factor analysis,including that may affect the prognosis of factors such as age,tumor stage,myometrial infiltration,sarcomas high level/heterologous mesenchymal,sarcomatous overgrowth,lymph node metastasis,surgical methods and postoperative chemotherapy and the expression of Ki-67,the HMGA2,found that surgical-pathologic staging(P<0.0001),sarcomas high level/heterologous mesenchymal(P=0.0328),lymph node metastasis(P<0.0001)of uterine adenosarcoma factors of overall survival,Surgical and pathological staging(P=0.0009),high grade/heterogenicity of sarcoma(P=0.0479),myometrial infiltration(P=0.0419),and lymph node metastasis(P<0.0001)were the factors affecting progression-free survival of uterine adenosarcoma.The expression of ki-67 and HMGA2 had no significant correlation with survival and tumor-free survivalConclusion1.HMGA2 was overexpressed in UA,and the ki-67 positive rate was positively correlated with the expression of HMGA2,but there was no significant correlation between the ki-67 positive rate and the expression of HMGA2 and the prognosis of uterine adenosarcoma.2.The adverse prognostic factors for UA included surgical and pathological stage,high grade/heterologous mesenchymal,myometrial infiltration and lymph node metastasis.3.Young low-risk UA patients can be considered to retain reproductive function after the exclusion of high-risk factors.Long-term follow-up is recommended due to the high recurrence rate...