绝经后子宫内膜癌患者MMR蛋白表达缺失的影响因素分析

Analysis of influencing factors of loss of MMR protein expression in postmenopausal patients with endometrial carcinoma

目的 探讨绝经后子宫内膜癌患者错误配对修复(MMR)蛋白表达缺失的影响因素。方法 选取62例绝经后子宫内膜癌手术患者为研究对象,以错误配对修复蛋白的表达为依据,将1种及以上错误配对修复蛋白表达缺失的22例患者纳入微卫星不稳定性(MSI)组,而4种错误配对修复蛋白表达不缺失的40例患者则纳入微卫星稳定型(MSS)组。检测统计并分析两组的临床资料[年龄、绝经年龄、体质量指数(BMI)、子宫内膜厚度、孕次、血清癌胚抗原(CEA)、睾酮(T)],采用Logistic回归分析绝经后子宫内膜癌患者错误配对修复蛋白表达的影响因素,并分析血清T、CEA水平对绝经后子宫内膜癌患者错误配对修复蛋白表达缺失的预测价值。结果 两组的年龄、绝经年龄、子宫内膜厚度、孕次均无显著性差异(P>0.05)。MSI组的血清CEA和T水平及BMI分别为(13.81±1.06)ng/ml、(59.94±9.16)ng/dl、(27.18±2.59)kg/m^(2), MSS组分别为(10.98±1.84)ng/ml、(52.16±11.31)ng/dl、(24.75±0.86)kg/m^(2);与MSS组相比, MSI组的血清CEA和T水平及BMI均较高,差异显著(P<0.05)。将绝经后子宫内膜癌患者血清CEA、T、BMI水平分别作为协变量,错误配对修复蛋白表达情况作为因变量(MSS=1, MSI=0),经Logistic回归分析结果显示,血清CEA、T、BMI水平升高是绝经后子宫内膜癌患者错误配对修复蛋白表达缺失的影响因素[OR(95%置信区间)=0.217(0.093, 0.507)、0.860(0.773, 0.956)、1.326(1.036, 1.697),P<0.05]。将子宫内膜癌患者错误配对修复蛋白表达缺失作为状态变量,血清T、CEA水平作为检验变量,绘制受试者工作特征曲线(ROC曲线),结果示血清T、CEA水平预测绝经后子宫内膜癌患者错误配对修复蛋白表达缺失的曲线下面积(AUC)分别为0.750、0.893,均具有预测价值。结论 血清CEA、T水平与绝经后子宫内膜癌患者错误配对修复蛋白表达缺失密切相关,其水平升高是患者MMR蛋白表达缺失的重要影响因素,临床可通过检测血清CEA、T水平,以评价错误配对修复蛋白表达缺失的可能性,并推测预后及优化治疗方法。

Objective To explore the influencing factors of loss of mismatch repair(MMR)protein expression in postmenopausal patients with endometrial carcinoma.Methods A total of 62 postmenopausal patients undergoing surgery for endometrial cancer were selected.Based on the expression of mismatch repair proteins,22 patients with loss of one or more mismatch repair proteins were included in the microsatellite instability(MSI)group,and 40 patients with no loss of four mismatch repair proteins were included in the microsatellite stability(MSS)group.The clinical data[age,age of menopause,body mass index(BMI),endometrial thickness,gravida,serum carcinoembryonic antigen(CEA),testosterone(T)]of the two groups were analyzed statistically.The influencing factors of mismatch repair protein expression in postmenopausal endometrial carcinoma patients were analyzed by Logistic regression.The predictive value of serum T and CEA levels on the loss of mismatch repair protein expression in postmenopausal patients with endometrial carcinoma was analyzed.Results There were no significant differences in age,age of menopause,endometrial thickness and gravida between the two groups(P>0.05).The serum CEA,T level and BMI in MSI group were(13.81±1.06)ng/ml,(59.94±9.16)ng/dl and(27.18±2.59)kg/m^(2),and those in MSS group were(10.98±1.84)ng/ml,(52.16±11.31)ng/dl and(24.75±0.86)kg/m^(2).Compared with MSS group,the serum CEA and T level and BMI in MSI group were higher,and the differences were significant(P<0.05).Serum CEA,T and BMI levels of postmenopausal patients with endometrial carcinoma were taken as covariables,and the expression of mismatch repair protein was taken as dependent variables(MSS=1,MSI=0).Logistic regression analysis showed that elevated serum CEA,T and BMI levels were influencing factors for loss of mismatch repair protein expression in postmenopausal patients with endometrial carcinoma[OR(95%confidence interval)=0.217(0.093,0.507);0.860(0.773,0.956);1.326(1.036,1.697);P<0.05].The loss of mismatch repair protein expression in patients with endometrial carcinoma was taken as state variable and serum T and CEA levels as test variables,and receiver operating characteristic(ROC)curve was drawn.The results showed that the area under the curve(AUC)of serum T and CEA levels in predicting the loss of mismatch repair protein expression in postmenopausal patients with endometrial carcinoma were 0.750 and 0.893,and all of them had predictive value.Conclusion Serum CEA and T levels are closely related to the loss of mismatch repair protein expression in postmenopausal patients with endometrial carcinoma,and the increase of their levels is an important factor affecting the loss of MMR protein expression in patients.Clinically,serum CEA and T levels can be detected to evaluate the possibility of loss of mismatch repair protein expression to speculate on the prognosis and optimize the therapeutic methods.