p53突变型子宫内膜癌免疫微环境特征及免疫治疗进展

doi:10.12280/gjfckx.20251450

摘要/Abstract

摘要：

p53突变型（p53-abnormal，p53abn）是子宫内膜癌中预后最差的分子亚型，其免疫微环境呈显著抑制性特征，包括CD8+T细胞功能耗竭、调节性T细胞富集、M2型巨噬细胞极化等表现。该亚型虽总体表现为低肿瘤突变负荷和高染色体不稳定性而导致弱的免疫原性，但有部分病例高表达程序性死亡受体配体1（programmed death ligand-1，PD-L1）并富集T细胞，呈现“热肿瘤”异质性。在治疗方面，免疫检查点抑制剂单药疗效有限，但多项Ⅲ期临床试验证实，免疫联合化疗、抗血管生成药物或多腺苷二磷酸核糖聚合酶[poly (ADP-ribose) polymerase，PARP]抑制剂可显著改善患者预后，尤其在晚期或复发的患者中。综述p53abn型子宫内膜癌的免疫微环境特征及其免疫治疗策略的研究进展，为临床精准分型、免疫治疗决策及联合方案优化提供理论依据和实践参考。

关键词: 基因，p53, 子宫内膜肿瘤, 癌, 肿瘤微环境, 免疫检查点抑制剂, 抗肿瘤联合化疗方案

Abstract:

The p53-abnormal (p53abn) subtype is the molecular subtype with the worst prognosis in endometrial cancer. Its immune microenvironment exhibits significant suppressive features, including functional exhausion of CD8+ T cells, enrichment of regulatory T cells, and polarization toward M2-type macrophages. Although this subtype generally demonstrates low tumor mutational burden and high chromosomal instability, resulting in weak immunogenicity, a subset of cases show high expression of programmed death-ligand 1 (PD-L1) and are enriched in T cells, displaying heterogeneity as 'hot tumors'. In terms of treatment, immune checkpoint inhibitors as monotherapy have limited efficacy. However, multiple phase Ⅲ clinical trials have confirmed that combining immunotherapy with chemotherapy, anti-angiogenic agents, or poly (ADP-ribose) polymerase (PARP) inhibitors can significantly improve patient outcomes, particularly in advanced or recurrent cases. This review summarizes the research progress on the characteristics of the immune microenvironment and immunotherapy strategies for p53abn endometrial cancer, providing theoretical foundations and practical reference for clinical precision subtyping, immunotherapy decision-making, and optimization of combination regimens.

Key words: Genes, p53, Endometrial neoplasms, Carcinoma, Tumor microenvironment, Immune checkpoint inhibitors, Antineoplastic combined chemotherapy protocols

相骁莹, 孙雅歌, 张云凤, 贾涵, 王悦. p53突变型子宫内膜癌免疫微环境特征及免疫治疗进展[J]. 国际妇产科学杂志, 2026, 53(3): 285-291.

XIANG Xiao-ying, SUN Ya-ge, ZHANG Yun-feng, JIA Han, WANG Yue. Research Advances in the Immune Microenvironment and Immunotherapy for p53-Abnormal Endometrial Carcinoma[J]. Journal of International Obstetrics and Gynecology, 2026, 53(3): 285-291.

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