血清S100A8和PD-L1联合超声检测在子宫内膜癌诊断及预后中的价值分析

Analysis of the diagnostic and prognostic value of serum S100A8 and PD-L1 combined with ultrasound detection in endometrial cancer

目的探究血清S100钙结合蛋白A8(S100A8)和程序性死亡配体-1(PD-L1)联合超声检测在子宫内膜癌诊断及预后中的价值。方法选取2020年4月至2022年4月于我院收治的确诊为子宫内膜癌的患者166例即为癌症组,按照国际妇产科联合会(FIGO)标准分为Ⅰ期48例、Ⅱ期52例、Ⅲ期42例、Ⅳ期24例。选择同期在我院确诊为子宫内膜增生的患者166例为对照组;使用酶联免疫吸附试验(ELISA)检测血清中S100A8和PD-L1水平;使用阴道超声获取血流频谱测得血流参数:搏动指数(PI)、阻力指数(RI)。采用受试者工作特征(ROC)曲线分析血清S100A8和PD-L1联合超声参数对子宫内膜癌的诊断价值以及预后的预测价值。结果与对照组相比,癌症组患者血清中S100A8和PD-L1水平显著升高(t=10.688、8.605,均P<0.001);与Ⅰ期相比,Ⅱ期、Ⅲ期、Ⅳ期患者血清中S100A8和PD-L1水平显著升高,与Ⅱ期相比,Ⅳ期患者血清中S100A8和PD-L1水平显著升高(P<0.05)。与对照组相比,癌症组PI和RI的值显著降低(t=7.183、6.799,均P<0.001);血清S100A8和PD-L1联合超声参数对子宫内膜癌诊断的曲线下面积(AUC)高于各指标单独诊断的AUC值(Z S100A8 vs.S100A8+PD-L1+PI+RI=6.472,Z PD-L1 vs.S100A8+PD-L1+PI+RI=6.903,Z PI vs.S100A8+PD-L1+PI+RI=7.072,Z RI vs.S100A8+PD-L1+PI+RI=5.987,均P<0.001);与预后良好组相比,预后不良组S100A8、PD-L1水平显著升高,PI、RI水平显著降低(P<0.001);血清S100A8和PD-L1联合超声参数对子宫内膜癌预后预测的AUC高于各指标单独预测的AUC值(Z S100A8 vs.S100A8+PD-L1+PI+RI=2.841,P=0.005;Z PD-L1 vs.S100A8+PD-L1+PI+RI=2.146,P=0.032;Z PI vs.S100A8+PD-L1+PI+RI=6.056,P<0.001;Z RI vs.S100A8+PD-L1+PI+RI=4.370,P<0.001)。结论子宫内膜癌患者血清中S100A8和PD-L1水平显著升高,血清S100A8和PD-L1联合超声能够提高对子宫内膜癌诊断及预后价值。

Objective To investigate the diagnostic and prognostic value of combined serum S100 calcium binding protein A8(S100A8)and programmed death ligand 1(PD-L1)with ultrasound detection in endometrial cancer.Methods A total of 166 patients diagnosed with endometrial cancer in our hospital from April 2020 to April 2022 were selected as the cancer group,and they were classified according to the International Federation of Gynecology and Obstetrics(FIGO)standards into 48 cases of stageⅠ,52 cases of stageⅡ,42 cases of stageⅢ,and 24 cases of stageⅣ.166 patients diagnosed with endometrial hyperplasia in our hospital were selected as the control group.Enzyme-linked immunosorbent assay(ELISA)was used to measure serum levels of S100A8 and PD-L1,and transvaginal ultrasound was used to obtain blood flow spectra and measure blood flow parameters:pulsatility index(PI)and resistance index(RI).The diagnostic value of combined serum S100A8,PD-L1,and ultrasound parameters for endometrial cancer,as well as their prognostic predictive value,were analyzed using receiver operating characteristic(ROC)curve analysis.Results Compared with the control group,the levels of serum S100A8 and PD-L1 in the cancer group were significantly elevated(t=10.688 and 8.605,respectively,P<0.001).Compared to stageⅠ,the levels of serum S100A8 and PD-L1 in stageⅡ,Ⅲ,andⅣpatients were significantly higher,and compared to stageⅡ,the levels of serum S100A8 and PD-L1 in stageⅣwere significantly elevated(P<0.05).Additionally,the PI and RI values in the cancer group were significantly lower than those in the control group(t=7.183 and 6.799,respectively,P<0.001).The area under the curve(AUC)for the combined diagnosis of endometrial cancer using serum S100A8,PD-L1,and ultrasound parameters was higher than the AUC for each individual marker(Z S100A8 vs.S100A8+PD-L1+PI+RI=6.472,P<0.001;Z PD-L1 vs.S100A8+PD-L1+PI+RI=6.903,P<0.001;Z PI vs.S100A8+PD-L1+PI+RI=7.072,P<0.001;Z RI vs.S100A8+PD-L1+PI+RI=5.987,P<0.001).Compared with the good prognosis group,the levels of S100A8 and PD-L1 in the poor prognosis group were significantly higher,while the levels of PI and RI were significantly lower(P<0.001).The AUC for predicting the prognosis of endometrial cancer using the combined serum S100A8,PD-L1,and ultrasound parameters was higher than the AUC for each individual marker(Z S100A8 vs.S100A8+PD-L1+PI+RI=2.841,P=0.005;Z PD-L1 vs.S100A8+PD-L1+PI+RI=2.146,P=0.032;Z PI vs.S100A8+PD-L1+PI+RI=6.056,P<0.001;Z RI vs.S100A8+PD-L1+PI+RI=4.370,P<0.001).Conclusion Serum levels of S100A8 and PD-L1 are significantly elevated in patients with endometrial cancer,and the combination of serum S100A8,PD-L1,and ultrasound can enhance the diagnostic and prognostic values for endometrial cancer.