多配体蛋白聚糖1表达水平与乳腺癌术后子宫内膜病变的相关性研究

Correlation research between expression level of SDC1 and endometrial lesions after breast cancer surgery

目的多配体蛋白聚糖1(recombinant syndecan 1,SDC1)表达水平与乳腺癌(breast cancer,BC)术后子宫内膜病变的相关性。方法从GEO数据库中检索并筛选出目的基因SDC1。收集山西省儿童医院73例经手术治疗的乳腺癌患者,依据子宫内膜病变将其分为未病变组与病变组,收集患者临床资料,分析两组患者血清SDC1表达水平。将病变组患者分为SDC1高表达组与低表达组,分析SDC1表达水平与患者临床病理参数的关联,评估SDC1表达水平诊断乳腺癌术后子宫内膜病变的敏感性。Logistic回归模型分析影响子宫内膜病变的独立危险因素。结果SDC1在病变组患者血清中表达水平(1.38±0.31)明显高于未病变组(1.00±0.33)(t=3.59,P=0.001)。病变组患者绝经占比80%(41/51)、子宫内膜厚度≥5 mm占比73%(37/51)、有子宫异常出血病史的患者占比78%(40/51)较未病变组的患者占比更多[18%(4/22)、27%(6/22)、9%(2/22)](P<0.001、0.004、<0.001)。SDC1高表达组中绝经占比95%(21/22)、子宫内膜厚度≥5 mm占比91%(20/22)、妊娠史≤2次患者占比64%(14/22)、有子宫异常出血病史患者占比95%(21/22)、选择性ER调节剂治疗91%(20/22)患者占比均高于低表达组[69%(20/29)、59%(17/29)、31%(9/29)、66%(19/29)、59%(17/29)](P=0.030、0.013、0.026、0.015、0.013)。受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积0.8102(95%CI=0.6966~0.9237,P<0.001),SDC1诊断子宫内膜发病敏感性高。在Logistic单因素分析中认为子宫异常出血史(是)(OR=36.36,95%CI=8.88~251.30,P<0.001)、SDC1表达(OR=1.50,95%CI=1.23~1.92,P<0.001)是子宫内膜病变的危险因素,而绝经(否)(OR=0.05,95%CI=0.01~0.18,P<0.001)、子宫内膜厚度(<5 mm)(OR=0.14,95%CI=0.04~0.42,P=0.001)是其保护因素。在Logistic多因素分析中认为子宫异常出血史(是)(OR=1.49e+6,95%CI=184.7~1.97e+16,P=0.042)、SDC1表达(OR=4.25,95%CI=1.59~24.55,P=0.029)是子宫内膜病变的独立危险因素,而绝经(否)(OR=0.00,95%CI=0.00~0.03,P=0.024)是其保护因素。结论SDC1表达水平与乳腺癌癌患者术后子宫内膜病变具有显著相关性,是子宫内膜病变的独立危险因素。

Objective To investigate the correlation between the expression level of SDC1 and endometrial lesions after breast cancer(BC)surgery.Methods The target gene SDC1 was retrieved and screened from GEO database.A total of 73 BC patients treated by surgery were collected and divided into non-lesion group and lesion group according to endometrial lesions.The clinical data of the patients were collected,and serum SDC1 expression levels of the two groups of patients were analyzed.The patients in the lesion group were divided into high expression group and low expression group of SDC1,the correlation between SDC1 expression level and clinicopathological parameters of patients was analyzed,and the sensitivity of SDC1 expression level in diagnosing endometrial lesions after BC surgery was evaluated.Logistic regression model was used to analyze the independent risk factors for endometrial lesions.Results The expression level of SDC1 in serum of patients with lesions(1.38±0.31)was significantly higher than that of patients without lesions(1.00±0.33)(t=3.59,P=0.001).The proportion of menopause[80%(41/51)],the proportion of endometrial thickness≥5 mm[73%(37/51)],and the patients with a history of abnormal uterine bleeding[78%(40/51)]in the lesion group were higher than those in the non-lesion group[18%(4/22),27%(6/22),9%(2/22)](P<0.001,0.004,<0.001).In the SDC1 high expression group,the proportion of menopause[95%(21/22)],the proportion of endometrial thickness≥5 mm[91%(20/22)],the proportion of patients with a history of pregnancy≤2 times[64%(14/22)],the proportion of patients with a history of abnormal uterine bleeding[95%(21/22)],and the proportion of patients treated with selective ER modulators[91%(20/22)]were higher than those in the low expression group group[69%(20/29),59%(17/29),31%(9/29),66%(19/29),59%(17/29)].The area under the receiver operating characteristic curve(ROC)was 0.8102(95%CI=0.6966-0.9237,P<0.001),and SDC1 had a high sensitivity in diagnosing endometrial disease.In Logistic univariate analysis,history of abnormal uterine bleeding(yes)(OR=36.36,95%CI=8.88-251.30,P<0.001)and SDC1 expression(OR=1.50,95%CI=1.23-1.92,P<0.001)were considered to be risk factors for endometrial lesions,while menopause(no)(OR=0.05,95%CI=0.01-0.18,P<0.001)and endometrial thickness(<5 mm)(OR=0.14,95%CI=0.04-0.42,P=0.001)were protective factors.In Logistic multivariate analysis,history of abnormal uterine bleeding(yes)(OR=1.49e+6,95%CI=184.7~1.97e+16,P=0.042)and SDC1 expression(OR=4.25,95%CI=1.59-24.55,P=0.029)were independent risk factors for endometrial lesions,while menopause(no)(OR=0.00,95%CI=0.00-0.03,P=0.024)was a protective factor.Conclusion The expression level of SDC1 is significantly correlated with postoperative endometrial lesions in BC patients,and is an independent risk factor for endometrial lesions.