血清肿瘤标志物水平在宫颈癌病情监测及预后评估中的价值

Significance of serum tumor markers for the condition monitoring and prognosis evaluation in patients with cervical cancer

目的 探讨血清肿瘤标志物水平在宫颈癌患者病情监测及预后评估中的价值。方法 选取2016年1月至2020年1月间上海市金山区亭林医院收治的300例宫颈肿瘤患者,其中宫颈良性疾病组患者165例,宫颈癌组患者135例,另选取100例健康体检者作为对照组。对三组血清甲胎蛋白(AFP)、癌胚抗原(CEA)和人附睾蛋白4(HE4)水平进行检测,分别记录AFP、CEA、HE4低表达与高表达宫颈癌患者的1年内生存时间。采用Kaplan-Meier法进行生存分析,诊断效果评价采用受试者工作特征(ROC)曲线。结果 三组血清AFP、CEA、HE4水平比较,差异有统计学意义(均P<0.05),且宫颈癌组血清AFP、CEA、HE4水平高于宫颈良性疾病组、对照组,差异有统计学意义(P<0.05);AFP、CEA、HE4诊断宫颈癌病情的敏感度77.5%~81.0%,特异度38.0%~91.0%。ROC曲线分析显示,AFP、CEA、HE4诊断宫颈癌病情的曲线下面积(AUC)分别为0.598、0.928、0.898。分别以血清AFP(3.62±1.23)ng/ml、CEA(6.90±2.32)ng/ml、HE4(68.12±10.22)pmol/L为分界点,高于上述值为高表达,低于上述值为低表达,血清AFP、CEA、HE4高表达宫颈癌患者1年内生存时间均短于低表达宫颈癌患者,差异有统计学意义(P<0.05)。结论 AFP、CEA、HE4诊断宫颈癌病情的敏感度较高,可作为宫颈癌病情的预测因子。血清AFP、CEA、HE4高表达的宫颈癌患者生存时间更短,可作为预测预后生存时间的敏感性指标。

Objective To investigate the value of serum tumor markers for the condition monitoring and prognosis evaluation in patients with cervical cancer. Methods A total of 300 patients with cervical cancer were selected at Tinglin Hospital, Jinshan District, Shanghai from January 2016 to January 2020, including 165 patients with benign cervical disease and 135 patients with cervical cancer, and additional 100 healthy individuals were selected and included in a control group. The serum alpha fetoprotein(AFP), carcinoembryonic antigen(CEA) and human epididymis protein 4(HE4) levels were detected among the three groups, and the 1-year survival was recorded in patients with low and high expression of AFP, CEA and HE4. Kaplan Meier method was used for survival analysis, and receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficacy. Results There were significant difference in the levels of AFP, CEA and HE4 among the three groups(F=33.43,181.08,150.13,all P<0.05), and the levels of AFP, CEA and HE4 were higher in the cervical cancer group than in the benign cervical disease group and the control group(all P<0.05). The sensitivity and specificity of AFP, CEA and HE4 for the diagnosis of cervical cancer were 77.5% to 81.0% and 38.0% to 91.0%, respectively. ROC curve analysis showed that area under curve(AUC) of AFP, CEA and HE4 for the diagnosis of cervical cancer were 0.598(95% CI 0.542 to 0.654), 0.928(95% CI 0.898 to 958) and 0.898(95% CI 0.863 to 0.933), respectively. When serum AFP, CEA, HE4 levels of 3. 62±1.23 ng/ml, 6.90 ± 2.32 ng/ml and 68.12±10.22 pmol/L were taken as the threshold, 1-year survival was shorter in patients with high expression of serum AFP, CEA and HE4 than in patients with low expression of serum AFP, CEA and HE4(all P<0.05). Log rank analysis also showed that the 1-year survival was significantly shorter in patients with high expression of serum AFP, CEA and HE4 than in patients with low expression of serum AFP, CEA and HE4(all P<0.05). Conclusion The serum levels of AFP, CEA and HE4 are high in patients with cervical cancer. Lymph node metastasis and clinical stage are associated with the serum levels of AFP, CEA and HE4 in patients with cervical cancer. AFP, CEA and HE4 have high sensitivity for the diagnosis of cervical cancer, and can be used as predictors for cervical cancer. The survival is short in patients with high expression of AFP, CEA and HE4, which can be used as a sensitive index to predict the prognosis of cervical cancer.