术前外周血指标及临床病理参数对子宫内膜癌淋巴结转移的预测价值

Predictive value of preoperative peripheral blood indicators and clinical pathological parameters for lymph node metastasis in patients with endometrial carcinoma

目的分析子宫内膜癌(EC)淋巴结转移的危险因素,探讨术前外周血指标及临床病理参数对EC淋巴结转移的预测价值。方法回顾性分析2018年1月至2023年7月山西医科大学第一医院收治的183例EC患者的临床资料。共有145例患者接受淋巴结清扫术,其中129例无淋巴结转移(无转移组),16例(11.03%)有淋巴结转移(转移组)。采用单因素分析和多因素logistic回归分析探讨EC患者淋巴结转移的危险因素,绘制受试者操作特征(ROC)曲线分析术前外周血糖类抗原125(CA125)与癌胚抗原(CEA)水平对EC患者淋巴结转移的预测价值。结果单因素分析结果显示,EC患者淋巴结转移与病理类型、国际妇产科联盟分期、子宫肌层浸润深度、肿瘤直径、附件受累、淋巴血管间隙浸润、宫颈间隙浸润及术前外周血CA125、糖类抗原19-9、人附睾蛋白4、CEA水平有关(P<0.05)。多因素logistic回归分析结果显示,病理类型为非子宫内膜样癌、淋巴血管间隙浸润、术前外周血CA125及CEA水平升高是EC患者淋巴结转移的独立危险因素(P<0.05)。ROC曲线分析结果显示,术前外周血CA125、CEA均对EC患者淋巴结转移有一定的预测价值(P<0.05)。结论EC患者淋巴结转移可能与非子宫内膜样癌病理类型、淋巴血管间隙浸润及术前外周血CA125、CEA水平升高有关。CA125及CEA均对EC患者淋巴结转移有一定的预测价值,有助于临床个体化治疗。

Objective To analyze the factors of lymph node metastasis(LNM)in endometrial carcinoma(EC)and to explore the predictive value of preoperative peripheral blood index and clinicopathological parameters for LNM in EC patients.Method A retrospective analysis was performed on 183 EC patients admitted to the First Clinical Medical College of Shanxi Medical University from January 2018 to July 2023.Of the 145 patients who underwent LNM,129 had no LNM(no LNM group)and 16(11.03%)had LNM(LNM group).Univariate analysis and multivariate logistic regression analysis were used to investigate the risk factors of LNM in EC patients.The predictive value of carbohydrate antigen 125(CA125)and carcinoembryonic antigen(CEA)levels for LNM in EC patients was analyzed by receiver operating characteristic(ROC)curve.Result Unifactor analysis showed that LNM in EC patients was correlated with pathological type,FIGO stage,depth of myometrium invasion,tumor diameter,attachment involvement,lymph vascular space invasion,cervical space invasion,preoperative peripheral blood CA125,carbohydrate antigen 19-9,human epididymis protein 4,and CEA levels(P<0.05).Multivariate logistic regression analysis showed that pathological types of non-endometrioid carcinoma,lymphatic space infi ltration,preoperative peripheral blood CA125 and CEA were independent infl uencing factors for LNM in EC patients(P<0.05).ROC curve analysis results showed that preoperative peripheral blood CA125,CEA alone had certain predictive value for LNM in EC patients(P<0.05).Conclusion Patients with EC have a high risk of LNM,which might be related to the patients’type of non-endometrioid carcinoma,lymphatic space infi ltration,preoperative peripheral blood CA125 and CEA levels.The individual and combined detection of CA125 and CEA have great value in predicting LNM status in EC patients,which is helpful for individualized treatment.