Гиперплазия эндометрия и микросателлитная нестабильность: возможности прогнозирования опухолевой трансформации эндометрия

Abstract

Introduction. Microsatellite instability leads to the appearance of neoantigens, which play a key role in oncogenesis. Given the contribution of microsatellite instability to the development of oncopathology, it seems relevant to define microsatellite instability as a marker of malignant transformation in endometrial hyperplasia, which is recognized as a precancerous process. The aim of the study was to develop a model for predicting the risk of malignant transformation of the endometrium in its hyperplasia based on the tumor microsatellite instability. Materials and methods. We performed a two-stage non-randomized retrospective study using histological, immunohistochemical, and statistical methods. In stage 1, a comparative analysis of the structural features of microsatellite instability in endometrial hyperplasia and the development of a model were performed to determine the risk of tumor transformation. In stage 2, we validated the developed model for the prediction of malignant transformation of endometrial hyperplasia. Results. Samples of endometrial hyperplasia with atypia and endometrial hyperplasia without atypia are characterized by a significantly lower expression of MLH1, PMS2, and MSH6 in relation to normal endometrial samples. The expression of these genes was at a significantly higher level in endometrial samples collected from endometrioid adenocarcinoma. The data on the patients’ age and the average area of immunopositive structures in relation to MMR antigens (i.e., MSH6 and MLH1) formed the basis for the development of a model for calculating the risk of oncogenic transformation. The sensitivity and specificity were 92.9% and 92.3%, respectively. Conclusion.The developed model of oncogenic transformation risk can be used to determine the management options of patients with endometrial hyperplasia. Keywords: microsatellite instability, endometrial hyperplasia, endometrial adenocarcinoma