外周血循环肿瘤细胞、人附睾蛋白4、糖类抗原199检测在子宫内膜样腺癌筛查及分期预测中的价值

Value of peripheral blood circulating tumor cells,human epididymal protein 4 and carbohydrate antigen 199 in screening and staging prediction of endometrioid adenocarcinoma

目的探讨术前外周血循环肿瘤细胞(CTC)、人附睾蛋白4(HE4)、糖类抗原199(CA199)单独和联合检测检查在子宫内膜样腺癌筛查及分期预测中的临床价值。方法选取2017年3月至2022年1月于中山大学肿瘤防治中心体检或就诊的293例子宫内膜正常体检者(正常组)、359例无非典型性子宫内膜增生患者(良性组)、381例子宫内膜样腺癌患者(恶性组)作为研究对象。观察3组及恶性组各分期CTC数量及HE4、CA199表达水平,以及单独和联合检测的阳性率,分析CTC、HE4、CA199单独和联合检测对子宫内膜样腺癌的诊断效能及分期的预测价值。结果3组CTC数量及HE4、CA199表达水平比较,差异有统计学意义(P<0.05);恶性组CTC数量及HE4、CA199表达水平高于良性组,差异有统计学意义(P<0.05);CTC、HE4、CA199单独和联合检测阳性率高于良性组和正常组,差异均有统计学意义(P<0.05)。恶性组各分期CTC数量及HE4表达水平差异有统计学意义(P<0.05),而各分期CA199表达水平差异无统计学意义(P>0.05)。恶性组各分期CTC、CA199、CTC+HE4、CTC+CA199、CTC+HE4+CA199检测阳性率比较,差异有统计学意义(P<0.05)。CTC+HE4+CA199检测组合对子宫内膜样腺癌诊断的受试者工作特征(ROC)曲线的曲线下面积、灵敏度、符合率、约登指数等高于其他检测组合及单项检测,CTC+HE4+CA199联合检测的曲线下面积、灵敏度和特异度分别为0.945、87.93%、92.79%。结论CTC+HE4+CA199联合检测对子宫内膜样腺癌筛查和分期预测的临床价值较高。

Objective To explore the clinical value of peripheral blood circulating tumor cells(CTC),human epididymal protein 4(HE4)and carbohydrate antigen 199(CA199)in screening and staging prediction of endometrioid adenocarcinoma.Methods From March 2017 to January 2022,293 patients with normal endometrium(normal group),359 patients without atypical endometrial hyperplasia(benign group)and 381 patients with endometrioid adenocarcinoma(malignant group)were selected as research subjects.The expression levels and positive rates of CTC,HE4 and CA199 in three groups and different stage of malignant group were observed,and the diagnostic efficacy and predictive value of CTC,HE4 and CA199 in three groups and different stage of malignant group were analyzed.Results The CTC number and expression levels of HE4 and CA199 in the three groups were significantly different(P<0.05).The expression levels of HE4 and CA199 in malignant group were significantly higher than those in benign group(P<0.05).The positive rates of CTC,HE4 and CA199 detected alone or in combination were higher than those in benign group and normal group(P<0.05).There were significant differences on the CTC number and the expression levels of HE4 in each stage of malignant group(P<0.05),but there was no significant difference on the expression levels of CA199 in each stage(P>0.05).The positive rates of CTC,CA199,CTC+HE4,CTC+CA199,CTC+HE4+CA199 in different stage of malignant group were significantly different(P<0.05).The area under receiver operating characteristic(ROC)curve,sensitivity,coincidence rate and Youden index of CTC+HE4+CA199 combined detection were higher than those of other detection combinations and single detection.The area under curve,sensitivity and specificity of CTC+HE4+CA199 combined detection were 0.945,87.93%and 92.79%respectively.Conclusion The combined detection of CTC+HE4+CA199 has high clinical value in screening and staging prediction of endometrioid adenocarcinoma.