子宫内膜癌患者血清肿瘤标志物与临床病理特征的相关性及其诊断价值分析

Correlation between serum tumor markers and clinicopathological features in patients with endometrial cancer and its diagnostic value

目的探讨子宫内膜癌患者血清肿瘤标志物与临床病理特征的相关性及其诊断价值。方法将2017年8月至2018年11月空军军医大学唐都医院收治的296例子宫内膜癌患者和350例子宫内膜增生患者分别纳入子宫内膜癌组和子宫内膜增生组,随机选取同期于该院体检的300例健康女性纳入对照组。比较三组研究对象血清糖类抗原125(carbohydrate antigen 125,CA125)、糖类抗原153(carbohydrate antigen 153,CA153)、糖类抗原50(carbohydrate antigen 50,CA50)和人附睾蛋白4(humanepidid ymal protein 4,HE4)水平,分析上述4种血清肿瘤标志物水平与子宫内膜癌患者临床病理特征的相关性及其诊断价值。结果子宫内膜癌组患者血清CA125、CA153、CA50和HE4水平均显著高于子宫内膜增生组和对照组(均P < 0.05)。而子宫内膜增生组和对照组研究对象血清CA125、CA153、CA50和HE4水平比较差异均无统计学意义(均P > 0.05)。子宫内膜癌组年龄≤ 45岁者的血清CA125、CA50水平均显著高于> 45岁者(均P < 0.05),有淋巴结转移者的血清CA125、CA50和HE4水平均显著高于无淋巴结转移者(均P < 0.05)。子宫内膜癌组浸润深度≤ 1/2者与浸润深度> 1/2者的血清肿瘤标志物水平比较差异均无统计学意义(均P > 0.05)。CA125、CA153、CA50和HE4水平对子宫内膜癌的单一诊断价值均不高,均表现为低灵敏度、高特异度,Youden指数均低于0.5,其中HE4的Youden指数最高(0.483)。多项指标联合检测能提高诊断灵敏度,但也降低了特异度,其中CA153 + CA50 + HE4联合检测的Youden指数最高(0.730)。结论血清CA125、CA153、CA50和HE4水平对子宫内膜癌均有一定的诊断价值,其中CA125、CA50均与患者年龄、淋巴结转移有关,HE4与淋巴结转移有关。CA153 +CA50 + HE4联合检测方案对子宫内膜癌的诊断效能最高。

Objective To investigate the correlation between serum tumor markers and clinicopathological features in patients with endometrial cancer and its diagnostic value. Method 296 cases of patients with endometrial cancer and 350 cases of patients with endometrial hyperplasia in Tangdu Hospital, Air Force Military Medical University from August 2017 to November 2018 were selected as endometrial cancer group and endometrial hyperplasia group respectively. Meanwhile, 300 healthy women received physical examination in that hospital during the same period were randomly selected as the research objects as control group. Serum levels of carbohydrate antigen 125 (CA125), carbohydrate antigen 153 (CA153), carbohydrate antigen 50 (CA50) and human epididymal protein 4 (HE4) were compared among three groups, and the correlation between these four serum tumor markers and clinicopathological characteristics, and their diagnostic value for endometrial cancer patients were analyzed. Result Serum levels of CA125, CA153, CA50 and HE4 in endometrial cancer group were significantly higher than those in endometrial hyperplasia group and control group (all P < 0.05). There were no significant differences in serum levels of CA125, CA153, CA50 and HE4 between endometrial hyperplasia group and control group (all P > 0.05). Serum levels of CA125 and CA50 in endometrial cancer patients with age ≤ 45 years old were significantly higher than those in patients with age > 45 years old (all P < 0.05). Serum levels of CA125, CA50 and HE4 in patients with lymph node metastasis were significantly higher than those without lymph node metastasis (all P<0.05). There were no significant differences in serum levels of four tumor markers between those with infiltration depth ≤ 1/2 and those with infiltration depth > 1/2 in endometrial cancer group (all P > 0.05). The levels of CA125, CA153, CA50 and HE4 were not very valuable for single diagnosis of endometrial cancer, which were characterized by low sensitivity and high specificity. And their Youden indexes were all lower than 0.5, among them the Youden index of HE4 is the highest (0.483). The combined detection of multiple indicators could increase the sensitivity, but also reduce the specificity. The Youden index of CA153 + CA50 + HE4 combined detection is the highest (0.730). Conclusion Serum levels of CA125, CA153, CA50 and HE4 have certain diagnostic value for endometrial cancer. CA125 and CA50 are related to age and lymph node metastasis, and HE4 is related to lymph node metastasis. The combined detection scheme of CA153 + CA50 + HE4 has the highest diagnostic efficiency for endometrial cancer.