摘要
目的探讨血清人附睾蛋白4(HE4)和糖类抗原125(CA125)联合检测诊断子宫内膜癌淋巴结转移的价值。方法选择2018年1月1日至2020年1月1日新乡医学院第一附属医院妇科收治的行规范手术治疗的91例子宫内膜癌患者为观察对象,收集患者的年龄、绝经状态、体质量指数(BMI)、癌组织肌层浸润深度、淋巴结转移等临床资料;术前2~3 d非月经期抽取患者空腹静脉血5 mL,检测血清HE4、CA125水平;根据术后病理报告结果统计子宫内膜癌患者的肌层浸润深度、有无盆腹腔淋巴结转移,判定血清HE4、CA125水平单独及联合检测诊断子宫内膜癌淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值及受试者工作特征曲线下面积(AUC)。结果91例患者中有淋巴结转移18例(19.78%),无淋巴结转移73例(80.22%)。血清HE4、CA125水平与子宫内膜癌患者的肌层浸润深度、淋巴结转移有关(P<0.05),与患者的年龄、绝经状态、BMI无关(P>0.05)。血清HE4诊断子宫内膜癌发生淋巴结转移的敏感度为83.33%,特异度为76.71%,阳性预测值为46.88%,阴性预测值为94.92%;CA125诊断子宫内膜癌发生淋巴结转移的敏感度为55.56%,特异度为65.75%,阳性预测值为28.57%,阴性预测值为85.71%;血清HE4和CA125联合检测诊断子宫内膜癌发生淋巴结转移的敏感度为94.44%,特异度为93.15%,阳性预测值为73.91%,阴性预测值为98.55%;血清HE4、血清CA125单项及联合检测诊断子宫内膜癌发生淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值比较差异有统计学意义(χ^(2)=7.712、14.857、11.465、7.853,P<0.05);血清HE4与CA125单项检测诊断子宫内膜癌发生淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值比较差异无统计学意义(χ^(2)=3.273、2.139、2.394、2.812,P>0.05);血清HE4诊断子宫内膜癌发生淋巴结转移的敏感度、阴性预测值与血清HE4和CA125联合检测比较差异无统计学意义(P>0.05),血清HE4诊断子宫内膜癌发生淋巴结转移的特异度、阳性预测值显著均低于血清HE4和CA125联合检测(P<0.05);血清CA125诊断子宫内膜癌发生淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值均低于血清HE4和CA125联合检测(P<0.05);血清HE4、CA12单独及联合检测诊断子宫内膜癌发生淋巴结转移的AUC分别为0.878[95%置信区间(CI):0.807~0.948]、0.899(95%CI:0.816~0.982)和0.966(95%CI:0.929~1.000),血清CA125单项检测诊断子宫内膜癌发生淋巴结转移的AUC高于血清HE4(P<0.05),血清HE4和CA125联合检测诊断子宫内膜癌患者发生淋巴结转移的AUC高于血清HE4、CA125单项检测(P<0.05)。结论血清HE4和CA125可作为诊断子宫内膜癌发生淋巴结转移的肿瘤标志物,联合检测HE4和C125对诊断子宫内膜癌发生淋巴结转移具有较高的价值。
Objective To explore the value of combined detection of serum human epididymal protein 4(HE4)and carbohydrate antigen 125(CA125)in the diagnosis of lymph node metastasis in endometrial cancer.Methods A total of 91 patients with endometrial cancer who underwent standardized surgical treatment in the Department of Gynecology of the First Affiliated Hospital of Xinxiang Medical University from January 1,2018 to January 1,2020 were selected as observation objects.The age,menopausal status,body mass index(BMI),the depth of cancer tissue muscle layer invasion,lymph node metastasis and other clinical data of the patients were collected.Five milliliter of fasting venous blood of patients in non-menstrual period before 2-3 days of operation was taken,and the levels of serum HE4 and CA125 were detected.According to the results of the postoperative pathology report,the depth of myometrial invasion and the presence or absence of pelvic and abdominal lymph node metastasis of patients with endometrial cancer were counted.The sensitivity,specificity,positive predictive value,negative predictive value and area under curve(AUC)of receiver operating characteristic of the serum HE4 and CA125 levels alone and in combination detection to diagnose lymph node metastasiss of endometrial cancer were determined.Results Among the 91 patients,18 cases(19.78%)had lymph node metastasis,73 cases(80.22%)had no lymph node metastasis.Serum HE4 and CA125 levels were related to the depth of myometrial invasion and lymph node metastasis of patients with endometrial cancer(P<0.05),but had no relation to the age,menopausal status and BMI of patients(P>0.05).The sensitivity of serum HE4 in diagnosing lymph node metastasis of endometrial cancer was 83.33%,the specificity was 76.71%,the positive predictive value was 46.88%,and the negative predictive value was 94.92%;the sensitivity of CA125 in diagnosing lymph node metastasis of endometrial cancer was 55.56%,the specificity was 65.75%,the positive predictive value was 28.57%,and the negative predictive value was 85.71%;the sensitivity of combined detection of serum HE4 and CA125 in the diagnosis of lymphnode metastasis of endometrial cancer was 94.44%,the specificity was 93.15%,the positive predictive value was 73.91%,and the negative predictive value was 98.55%.There were significant differences in the sensitivity,specificity,positive predictive value and negative predictive value of combined detection of serum HE4 and CA125,single detection of serum HE4,and single detection of serum CA125 for the diagnosis of lymph node metastasis of endometrial cancer(χ^(2)=7.712,14.857,11.465,7.853;P<0.05);among them,there were no significant differences in the sensitivity,specificity,positive predictive value and negative predictive value between the single detection of serum HE4 and single detection of serum CA125 in the diagnosis of lymph node metastasis of endometrial cancer(χ^(2)=3.273,2.139,2.394,2.812;P>0.05);the sensitivity and negative predictive value of serum HE4 in the diagnosis of lymph node metastasis of endometrial cancer were not statistically different from those of combined detection of serum HE4 and CA125(P>0.05);the specificity and positive predictive value of single detection of serum HE4 in the diagnosis of lymph node metastasis of endometrial cancer were significantly lower than those of the combined detection of serum HE4 and CA125(P<0.05);the sensitivity,specificity,positive predictive value and negative predictive value of single detection of serum CA125 in the diagnosis of lymph node metastasis of endometrial cancer were significantly lower than those of the combined detection of serum HE4 and CA125(P<0.05).The AUC of serum HE4 and CA125 in alone and combination for diagnosis of lymph node metastasis of endometrial cancer were 0.878[95%confidence interval(CI):0.807-0.948],0.899(95%CI:0.816-0.982)and 0.966(95%CI:0.929-1.000),respectively;the AUC of single detection of serum CA125 in the diagnosis of lymph node metastasis of endometrial cancer was significantly higher than that of serum HE4(P<0.05),and the AUC of combined detection of serum HE4 and CA125 in the diagnosis of lymph node metastasis of endometrial cancer was significantly higher than that of single detection of serum HE4 and CA125(P<0.05).Conclusion Serum HE4 and CA125 can be used as tumor markers for the diagnosis of lymph node metastasis of endometrial cancer,and the combined detection of HE4 and C125 has high value in the diagnosis of lymph node metastasis of endometrial cancer.
作者
白云云
王世进
李赟
BAI Yunyun;WANG Shijin;LI Yun(Department of Gynecology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Department of Oncology,Beijing Nuclear Industry Hospital,Beijing 100012,China)
出处
《新乡医学院学报》
CAS
2021年第8期725-729,共5页
Journal of Xinxiang Medical University
基金
河南省科技厅科技发展计划项目(编号:162102310494)。
关键词
子宫内膜癌
人附睾分泌蛋白4
糖类抗原125
淋巴结转移
endometrial cancer
human epididymal protein 4
carbohydrate antigen 125
lymph node metastasis
