Reid阴道镜评分、HPV E6/E7 mRNA表达量在宫颈癌中的临床应用价值研究

Study on clinical application value of Reid colposcopy score and HPV E6/E7 mRNA expression level in cervical cancer

目的研究Reid阴道镜评分(以下简称Reid评分)、高危型人乳头瘤病毒(HR-HPV)mRNA表达量与宫颈癌国际妇产科联盟(FIGO)分期、血清常规肿瘤标志物水平的相关性及对宫颈癌术后淋巴结转移的预测价值。方法选取2021年3月至2022年5月在菏泽市立医院就诊的100例宫颈癌患者作为宫颈癌组,另选同期诊治的50例低级别鳞状上皮内病变(LSIL)患者作为LSIL组,50例高级别鳞状上皮内病变(HSIL)患者作为HSIL组。比较3组Reid评分、HPV E6/E7 mRNA表达量及血清常规肿瘤标志物[糖类抗原125(CA125)、癌胚抗原(CEA)]水平;分析宫颈癌组Reid评分、HPV E6/E7 mRNA表达量与血清常规肿瘤标志物水平及宫颈癌FIGO分期的相关性;根据宫颈癌组患者术后随访结果分为术后有淋巴结转移和无淋巴结转移,比较有无淋巴结转移患者Reid评分、HPV E6/E7 mRNA表达量及血清CA125、CEA水平,分析Reid评分、HPV E6/E7 mRNA表达量对宫颈癌术后淋巴结转移的预测价值。结果宫颈癌组Reid评分、HPV E6/E7 mRNA表达量及血清CA125、CEA水平均高于HSIL组、LSIL组(P<0.05);HSIL组Reid评分、HPV E6/E7 mRNA表达量及血清CA125、CEA水平均高于LSIL组(P<0.05)。宫颈癌患者Reid评分、HPV E6/E7 mRNA表达量与血清CA125、CEA水平均呈正相关(r=0.405~0.705,P<0.05)。Reid评分、HPV E6/E7 mRNA表达量与宫颈癌FIGO分期呈正相关(r=0.415、0.501,P<0.05)。宫颈癌组术后淋巴结转移患者的Reid评分、HPV E6/E7 mRNA表达量及血清CA125、CEA水平均高于无淋巴结转移的患者(P<0.001)。Reid评分、HPV E6/E7 mRNA表达量、CA125、CEA预测宫颈癌术后淋巴结转移的曲线下面积(AUC)分别为0.756(95%CI:0.657~0.838)、0.760(95%CI:0.662~0.841)、0.803(95%CI:0.710~0.877)、0.768(95%CI:0.670~0.848)。将CA125、CEA联合检测作为常规预测方案,Reid评分、HPV E6/E7 mRNA表达量、CA125、CEA联合检测作为新预测方案,常规预测方案预测宫颈癌术后淋巴结转移的曲线下面积(AUC)为0.826(95%CI:0.724~0.889),新预测方案预测宫颈癌术后淋巴结转移的AUC为0.955(95%CI:0.892~0.987),新预测方案预测的AUC明显大于常规预测方案(Z=1.981,P=0.045)。与常规预测方案比较,新预测方案的净重新分类指数为0.021(95%CI:0.015~0.039)、综合判别改善指数为0.046(95%CI:0.033~0.069),均P<0.05。结论Reid评分、HPV E6/E7 mRNA表达量与宫颈癌FIGO分期及血清CEA、CA125水平相关,且在预测宫颈癌术后淋巴结转移方面具有一定价值。

Objective To investigate the correlation between the Reid colposcopy score(Reid score)and high-risk human papillomavirus(HR-HPV)mRNA expression level with the International Federation of Gynecology and Obstetrics(FIGO)stage and serum routine tumor marker levels in the patients with cervical cancer and its predictive value for postoperative lymph node metastasis.Methods A total of 100 patients with cervical cancer diagnosed and treated in Heze Municipal Hospital from March 2021 to May 2022 were selected as the cervical cancer group,50 cases of low-grade squamous intraepithelial lesions(LSIL)during the same period served as the LSIL group,and 50 cases of high-grade squamous intraepithelial lesions(HSIL)as the HSIL group.The Reid score,HPV E6/E7 mRNA expression level and serum routine tumor marker[carbohydrate antigen 125(CA125),carcinoembryonic antigen(CEA)]levels were compared among the three groups.The correlation between the Reid score and HPV E6/E7 mRNA expression level with serum routine tumor marker levels and cervical cancer FIGO stage in the cervical cancer group was analyzed;according to the postoperative follow-up results of the patients with cervical cancer,the patients were divided into the patients with postoperative lymph node metastasis and the patients without postoperative lymph node metastasis.The Reid score,HPV E6/E7 mRNA expression level and serum CA125 and CEA levels were compared between the patients with lymph node metastasis and the patients without lymph node metastasis.The predictive value of Reid score and HPV E6/E7 mRNA expression level on postoperative lymph node metastasis of cervical cancer was analyzed.Results The Reid score,HPV E6/E7 mRNA expression level and serum CA125 and CEA levels in the cervical cancer group were higher than those in the HSIL group and LSIL group(P<0.05);the Reid score,HPV E6/E7 mRNA expression level and serum CA125 and CEA levels in the HSIL group were higher than those in the LSIL group(P<0.05).The Reid score and HR-HPV E6/E7 mRNA expression level in the patients with cervical cancer were positively correlated with serum CA125 and CEA levels(r=0.405-0.705,P<0.05).The Reid score,HPV E6/E7 mRNA expression level were positively correlated with the FIGO stage of cervical cancer(r=0.415,0.501,P<0.05).The Reid score,HPV E6/E7 mRNA expression level and serum CA125 and CEA levels in cervical cancer patients with postoperative lymph node metastasis were higher than those in the patients without lymph node metastasis(P<0.05).The area under the curve(AUC)of Reid score,HPV E6/E7 mRNA expression level,CA125 and CEA for predicting postoperative lymph node metastasis in cervical cancer were 0.756(95%CI:0.657-0.838),0.760(95%CI:0.662-0.841),0.803(95%CI:0.710-0.877),and 0.768(95%CI:0.670-0.848),respectively.The combined detection of CA125 and CEA was used as the conventional detection scheme,while the Reid score,HPV E6/E7 mRNA expression level,CA125 and CEA combined prediction were used as the new prediction scheme.AUC of the conventional prediction scheme for predicting postoperative lymph node metastasis of cervical cancer was 0.826(95%CI:0.724-0.889),while AUC of the new prediction scheme for predicting postoperative lymph node metastasis of cervical cancer was 0.955(95%CI:0.892-0.987).AUC of the new prediction scheme was significantly greater than that of the conventional prediction scheme(Z=1.981,P=0.045).Compared with the conventional prediction scheme,the net reclassification index of the new prediction scheme was 0.021(95%CI:0.015-0.039),and the comprehensive discrimination improvement index was 0.046(95%CI:0.033-0.069),both P<0.05.Conclusion The Reid score and HPV E6/E7 mRNA expression level are correlated to the FIGO stage of cervical cancer and serum CA125 and CEA levels,moreover which have certain value in predicting lymph node metastasis after cervical cancer surgery.