Seröz Ve Müsinöz Over Kanserleri İle Ki-67 İlişkisi

Yıl 2010, Cilt: 67 Sayı: 2, 79 - 84, 01.06.2010

Faruk Abıke Sema Zengeroğlu Osman Temızkan Ahmet Payaslı Ömer Lütfi Tapısız

Öz

Amaç: Ki-67, tümör içerisindeki prolifere hücreleri gösterebilen bir antikordur. Ki67 fraksiyonunun daha yüksek olduğu tümörler, daha agresif seyretme eğilimindedirler ve bu vakalarda vasküler invazyona, kötü proliferasyona ve metastaza daha sık rastlanır. Bu çalışmada kolorektal ve mesane karsinomlarında proliferasyon belirteci olarak kullanılan Ki67’nin seröz ve müsinöz over kanserlerinde tümör proliferatif indeksi olarak kullanılabilirliği ve prognoza etkisinin incelenmesi amaçlanmıştır.Yöntem: Bu çalışmada, 1996-2000 yılları arasında, yaşları 17-82 arasında, jinekolojik onkoloji kliniğinde opere edilen, patolojik olarak seröz veya müsinöz over karsinomu tanısı alan 51 olgu değerlendirilmiştir. Patolojideki materyaller rutin doku takip işlemlerinden geçirildikten sonra hazırlanan parafin bloklardan 5 mm’lik kesitler yapılmış ve hematoksilen eozinle HE boyanarak değerlendirilmiştir. Operasyon sonrası alınan tümör örneklerinin rutin patolojik işlemlerden sonra streptoavidin-biotin ortamında primer antikorlar ile Ki-67 immünreaktivitesi değerlendirilmiştir. Bulgular: Patolojik olarak seröz over karsinomu tanısı alan 29 olgu ve müsinöz over karsinomu tanısı alan 22 olgu, stage, grade ve lenf nodu tutulumu açısından değerlendirilmiştir. Seröz tümörlerin % 48’i n=14 Ki67 pozitif saptanırken, müsinöz tümörlerde % 68 n=15 Ki 67 pozitifliği saptanmıştır. Seröz tümörlerde Ki-67 indeksi 13,05; müsinöz tümörlerde ise 22,2 olarak tespit edilmiştir p=0,072 . Tümörün histolojik tipi ile Ki-67 indeksleri arasında korelasyon saptanamamıştır. Ki-67 immünoreaktivitesi ile seröz ve müsinöz over karsinomları arasında stage, grade ve lenf nodu tutulumu ilişkisi araştırılmıştır. Stage artışına paralel olarak Ki-67 reaktivitesi artarken p0.05 .Sonuç: Seröz ve müsinöz karsinomların stage’i artıkça Ki-67 immünreaktivitesi ve proliferatif indekslerinin arttığı bulunmuştur. Buna karşın grade, lenf nodu tutulumu ve histolojik tümör tipi ile Ki-67 reaktivitesi arasında bağlantı saptanmamıştır. Bu bulgular eşliğinde seröz ve müsinöz over kanserlerinde proliferasyon markeri olarak Ki-67 ekspresyonu kullanımının duyarlı bir yöntem olmadığı sonucuna varılmıştır. Seröz ve müsinöz over kanserlerinde proliferasyon markeri olarak Ki-67 kullanımı uygun görülmemekle beraber daha geniş sayıda randomize çalışmaya gerek bulunmaktadır

Anahtar Kelimeler

Seröz over karsinomu, müsinöz over karsinomu, Ki-67, proliferasyon indeksi

Correlation Between Ki-67 and Serous-Mucinous Ovarian Carcinomas

Öz

Objective: Ki 67 is a antibody which could be showed proliferation in the cells. High Kİ 67 expression of some tumors have been more aggressive clinical progression, poor prognosis, more vascular invasion and more metastasis than Ki 67 negative tumors. In this study, it was aimed to determine the possibility of using Ki-67, which shows proliferation in serous and mucinous ovarian tumors, as a tumor proliferation index and effect on prognosis.Method: The correlation between Ki-67 and primary antibodies was examined in 51 cases, ages 17-82, which were in the period 1996-2000 pathologically diagnosed, by the routine processes of the pathological preparates in streptoavidin-biotin environment, to have serous and mucinous ovarian carcinomas. Pathologic determination was made Hematoxlene Eosine painting after the routine preparing. Results: It were diagnosed as serous n=29 and musinous n=22 which was determined according to stage, grade and lymph node involment. Ki 67 seropositivity was estabilished in 48 % n=14 of serous and 68 % n=15 of musinous tumors. Ki 67 indexes were found 13,05 in serous and 22,2 in musinous ovarian tumors p=0,072 . There was no correlation between tumour histology and Ki 67 indexes. Correlations between immunoreactivity of Ki-67 and the stage, grade and lymph node metastasis in serous and mucinous ovarian carcinoma were determined. Ki-67 indexes were increased as tumor stage was increased p0.05 .Conclusion: It was determined that as the stage of the serous and mucinous ovarian carcinomas are increased, Ki67 immunoreactivity and proliferation index are also increased. On the other hand, grade, lymph node involvement and histological tumor type were not correlated with Ki-67 reactivity. As a result, Ki-67 can not be used as a sensitive tumor proliferation index in serous and mucinous ovarian carcinomas. It isn’t found suitable that Ki 67 as proliferation marker in ovarian serous and musinous tumors but It needs to more widely randomized study about this issue

Anahtar Kelimeler

Serous ovarian carcinomas, mucinous ovarian carcinomas, Ki-67, proliferation index

Kaynakça

• Dodd JK, Henry RJW, Tyler PP. Tumor immunology and other post defense mechanism. Gynecol Oncol, 1989; 16: 560-613.
• Sciarra JJ, Knapp RC,Berhomitz RS. Naturel history and detection of ovarian cancer. Gynecology and Obstetrics, 1984; 28: 1-14.
• Yavuz H, Tezcan S, Erk A. Kadın genital kanserleri. Bölüm 9: Over karsinomları. 1978; 385-438.
• Julian CG, Goss J, Blanchard K, Woodruff JD. Biologic behavior of primary ovarian malignancy. Gynecol Oncol, 1974;873-4.
• Julian CG, Woodruff JD. The biological behavior of low grade papillary serous carcinoma of the ovary. Obstet Gynecol, 1972;40: 860-7.
• Genodry R, Poliakoff S, Rotmensch J, Rosenshein NB, Parmley TH, Woodruff JD. Primary papillary peritoneal neoplasia. Cancer, 1988; 62: 2212-22.
• Bell DA. Ovarian surface epithelial – stromal tumors. Hum Pathol, 1991; 22:750-62.
• Yancih R, Ries LG and Yartes JW. Ovarian cancer in the elderly; an analysis of surveillance, epidemiology and results data. Am J Obs Gynecol, 1986; 154: 639-47.
• Runnebaum IB and Stickeler E. Epidemiological and molecular aspects of ovarian cancer risk. J Cancer Res Clin Oncol, 2001; 127: 73-9.
• Shi HR, Key MC, Kalra KL. Antigen retrevial in formalin fixed, paraffin embedded tissues; an enhancement method for immunohistochemical staining based on microwave oven heating of tissue sections. J Histochem Cytochem, 1991; 59:741-8.
• Sessa F, Bonato M, Bisoni D, Ranzani GN, Capella C. Ki-ras and p53 gene mutations in pancreatic ductal carcinoma: a relationship with tumor phenotype and survivle. Eur J Histochem, 1998; 42:67-76.
• Nguyen HN, Averette HE, Hoskins W, Sevin BU, Penalv1er M, Steren A. National Survey of Ovarian Carcinoma VI. Critical Assessment of Current International Federation of Gynecology and Obstetrics Staging System . Cancer. 1993; 72: 10.
• Chen SS, Lee L. Incidence of paraaortic and pelvic lymph node metastasis in epithelial ovarian cancer. Gynecol Oncol, 1983; 16: 95-100.
• Smith LH and Oi RH. Detection of malignant ovarian neoplasms, a review of the literature. Detection of thw patient at risk, clinical, radiological and cytological detection. Obstet Gynecol Surv, 1984; 39: 313-28.
• Snider DD, Stuart GC, Nation JG and Robertson DI. Evaluation of surgical staging in stage 1 low malignant potential ovarian tumors. Gynecol Oncol, 1991; 40: 129-32.
• Lewis E, Wallace WS. Radiologic Diagnosis of Ovarian Cancer. In: Piver MS, ed. Ovarian Malignancies. Edinburgh: Churchill Livingstone 1987: 59-80.
• Sengupta PS, McGown AT, Bajaj V, Blackhall F, Swindell R, Bromley M, Shanks JH, Ward T, Buckley CH, Reynolds K, Slade RJ, Jason GC. p53 and related proteins in epithelial ovarian cancer. Eur J Cancer, 2000;36(18):2317-28.
• Salmaso R, Zen T, Zannol M, Perin D, Marchiori S, Marchetti M. Prognostic value of protein p53 and ki67 in invasive vulvar squamous cell carcinoma. Eur J Gynaecol Oncol, 2000;21(5):479-83.
• Stefansson IM, Salvesen HB, İmmervoll H, Akslen LA. Prognostic impact of histological grade and vascular invasion compared with tumor cell proliferation in endometrial carcinoma of endometrioid type. Histopathology, 2004;44(5):472-9.
• Salvesen HB, Das S, Akslen LA. Loss of nuclear p16 protein expression is not associated with promoter methylation but defines a subgroup of aggressive endometrial carcinomas with poor prognosis. Clin Cancer Res.2000;6(1):153-9.
• Salvesen HB, Iversen OE, Akslen LA. Identification of high-risk patients by assesment of nuclear Ki-67 expression in a prospective study of endometrial carcinomas. Clin Cancer Res. 1998;4(11):2779-85.