血清PKN1、TNFRSF4、DDIT4预测子宫内膜癌患者淋巴结转移及预后的临床价值

Clinical value of serum PKN1,TNFRSF4 and DDIT4 in predicting lymph node metastasis and prognosis of patients with endometrial cancer

目的探讨血清蛋白激酶N1(PKN1)、肿瘤坏死因子受体超家族成员4(TNFRSF4)、DNA损伤诱导转录因子4(DDIT4)预测子宫内膜癌患者淋巴结转移和预后的临床价值。方法选取2019年10月至2021年10月于唐山市妇幼保健院治疗的180例子宫内膜癌患者为子宫内膜癌组。另选取同期在该院治疗的子宫良性疾病患者180例作为良性疾病组,以及在该院体检的180例健康者作为健康组。子宫内膜癌组根据是否发生淋巴结转移分为淋巴结转移组42例和无淋巴结转移组138例,按照随访结果将患者分为预后不良组和预后良好组。比较各组血清PKN1、TNFRSF4、DDIT4水平,Logistic模型分析患者预后的影响因素,以及绘制受试者工作特征曲线分析血清PKN1、TNFRSF4、DDIT4对患者预后的预测价值。结果与健康组比较,子宫内膜癌组、良性疾病组血清PKN1、DDIT4水平升高,血清TNFRSF4水平降低,差异有统计学意义(P<0.05)。淋巴结转移组血清PKN1、DDIT4水平高于无淋巴结转移组,TNFRSF4水平低于无淋巴结转移组,差异有统计学意义(P<0.05)。预后不良组低分化程度、淋巴脉管间隙浸润阳性、肌层浸润≥1/2的占比高于预后良好组,差异有统计学意义(P<0.05)。预后不良组血清PKN1、DDIT4水平高于预后良好组,TNFRSF4水平低于预后良好组,差异有统计学意义(P<0.05)。血清PKN1、DDIT4、LVSI、肌层浸润是子宫内膜癌预后的危险因素,血清TNFRSF4为子宫内膜癌预后的保护因素(P<0.05)。血清PKN1、TNFRSF4、DDIT4联合对子宫内膜癌患者预后状况的预测效能高于各血清指标单独预测(P<0.05)。结论血清PKN1、TNFRSF4、DDIT4与子宫内膜癌患者淋巴结转移及预后有关,且对患者预后的预测效能较高。

Objective To explore the clinical value of serum protein kinase N1(PKN1),tumor necrosis factor receptor superfamily member 4(TNFRSF4),and DNA damage-inducible transcription factor 4(DDIT4)in predicting lymph node metastasis and prognosis of patients with endometrial cancer.Methods A total of 180 cases of endometrial cancer patients treated in Tangshan Maternal and Child Health Hospital from October 2019 to October 2021 were selected as endometrial cancer group.In addition,180 patients with benign uterine diseases treated in this hospital during the same period were selected as the benign disease group,and 180 healthy patients who underwent physical examination in this hospital were selected as the healthy group.The endometrial cancer group was divided into 42 cases with lymph node metastasis and 138 cases without lymph node metastasis according to whether lymph node metastasis occurred.The patients were divided into poor prognosis group and good prognosis group according to the follow-up results.The levels of serum PKN1,TNFRSF4 and DDIT4 in each group were compared,the influencing factors of patient prognosis were analyzed by Logistic model,and the predictive value of serum PKN1,TNFRSF4 and DDIT4 on prognosis of patients was analyzed by drawing the receiver operating characteristic curve.Results Compared with the healthy group,the levels of serum PKN1 and DDIT4 in endometrial cancer group and benign disease group were increased,and the levels of serum TNFRSF4 were decreased,with statistical significance(P<0.05).The serum levels of PKN1 and DDIT4 in lymph node metastasis group were higher than those in no lymph node metastasis group,and the levels of TNFRSF4 were lower than those in no lymph node metastasis group,with statistical significance(P<0.05).The proportion of poor prognosis group with low differentiation degree,positive lymphovascular space invasion and myometrial infiltration≥1/2 was higher than that of good prognosis group,and the difference was statistically significant(P<0.05).The levels of serum PKN1 and DDIT4 in the poor prognosis group were higher than those in the good prognosis group,and the levels of TNFRSF4 were lower than those in the good prognosis group,with statistical significance(P<0.05).Serum PKN1,DDIT4,LVSI and myometrial infiltration were risk factors for the prognosis of endometrial cancer,and serum TNFRSF4 was protective factor for the prognosis of endometrial cancer(P<0.05).Serum PKN1,TNFRSF4 and DDIT4 combined predicted the prognosis of patients with endometrial cancer more effectively than each serum index alone(P<0.05).Conclusion Serum PKN1,TNFRSF4 and DDIT4 are related to lymph node metastasis and prognosis of patients with endometrial cancer,and have high predictive efficacy for patient prognosis.