不同FIGO分期子宫内膜癌患者血清sFlt1、PTEN、Gal-9的表达水平及其与1年预后的关系

Expression levels of serum sFlt1,PTEN,and Gal-9 in patients with endometrial cancer at different FIGO stages and their correlation with 1-year prognosis

目的 探讨不同FIGO分期子宫内膜癌(EC)患者血清可溶性血管内皮生长因子受体1 (sFlt1)、半乳凝素-9 (Gal-9)、同源丢失性磷酸酶张力蛋白(PTEN)表达水平的差异及其与1年预后的关系。方法 前瞻性选取2021年1月至2023年4月驻马店市第一人民医院收治的EC患者120例作为研究组,选取同期医院体检的120例健康女性作为对照组。比较两组、研究组不同FIGO分期患者血清s Flt1、PTEN、Gal-9水平,Spearman相关性分析血清s Flt1、PTEN、Gal-9水平与FIGO分期的相关性。研究组EC患者随访1年,对比预后患者的基线资料、血清s Flt1、PTEN、Gal-9水平,偏相关性分析血清s Flt1、PTEN、Gal-9与1年预后的关系,受试者工作特征(ROC)曲线及曲线下面积(AUC)分析血清s Flt1、PTEN、Gal-9对1年预后的预测价值。结果 研究组和对照组受检者的血清sFlt1[(70.24±21.58) pg/mL vs (104.61±30.79) pg/mL]、PTEN [(0.32±0.08) pg/mL vs (0.63±0.14) pg/mL]水平比较,研究组明显低于对照组,Gal-9 [(30.12±7.15) ng/L vs (14.80±3.11) ng/L]水平比较,研究组明显高于对照组,差异均有统计学意义(P<0.05);血清s Flt1、PTEN水平随着FIGO分期增加而降低,Gal-9水平随着FIGO分期增加而升高,差异均有统计学意义(P<0.05);Spearman相关性分析结果显示,血清sFlt1、PTEN水平与FIGO分期呈负相关(r=-0.689、-0.678,P<0.05),Gal-9水平与FIGO分期呈正相关(r=0.671,P<0.05);预后良好组与预后不良组患者FIGO分期、肌层浸润程度比较差异均有统计学意义(P<0.05);预后不良组与预后良好组患者的血清s Flt1 [(49.14±15.13) pg/mL vs (78.43±21.17) pg/mL]、PTEN [(0.22±0.06) pg/mL vs (0.36±0.08) pg/mL]水平比较,预后不良组明显低于预后良好组,Gal-9[(36.40±7.12) ng/L vs (27.68±6.43) ng/L]水平比较,预后不良组明显高于预后良好组,差异均有统计学意义(P<0.05);偏相关性分析结果显示,血清sFlt1、PTEN、Gal-9与EC患者1年预后呈显著相关(P<0.05);血清sFlt1、PTEN、Gal-9联合预测EC患者1年预后的曲线下面积为0.923,约登指数为0.707,敏感度为84.85%,特异度为85.88%,优于三者单独预测(P<0.05)。结论 EC患者血清s Flt1、PTEN、Gal-9水平与FIGO分期、预后密切相关,s Flt1、PTEN、Gal-9联合检测有助于提高EC患者1年预后的预测价值,为临床评估疾病转归提供参考。

Objective To explore the differences in the expression levels of soluble vascular endothelial growth factor receptor 1(sFlt1),galectin-9(Gal-9),and phosphatase and tensin homolog(PTEN)in serum of patients with endometrial cancer(EC)at different FIGO stages,as well as their relationship with 1-year prognosis.Methods A prospective study was conducted on 120 EC patients admitted to Zhumadian First People's Hospital from January 2021 to April 2023(the study group)and 120 healthy women who underwent physical examinations at the same hospital during the same period(the control group).The serum levels of sFlt1,PTEN,and Gal-9 were compared between the two groups and among patients with different FIGO stages in the research group.Spearman correlation analysis was used to investigate the correlation between serum levels of sFlt1,PTEN,and Gal-9 and FIGO stage.The EC patients in the study group were followed up for 1 year,and the baseline data,serum levels of sFlt1,PTEN,and Gal-9 of the patients with good prognosis were compared.Partial correlation analysis was conducted to explore the relationship between serum levels of sFlt1,PTEN,and Gal-9 and 1-year prognosis.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the predictive value of serum levels of sFlt1,PTEN,and Gal-9 for 1-year prognosis.Results The levels of serum sFlt1 and PTEN in the study group were significantly lower than those in the control group(P<0.05):sFlt1,(70.24±21.58)pg/mL vs(104.61±30.79)pg/mL;PTEN,(0.32±0.08)pg/mL vs(0.63±0.14)pg/mL;the level of Gal-9 in the study group was significantly higher (P<0.05): (30.12±7.15) ng/L vs (14.80±3.11) ng/L. The levels of serum sFlt1 and PTEN decreased with increasing FIGO stage, while the level of Gal-9 increased with increasing FIGO stage, with statistically significant differences (P<0.05). Spearman correlation analysis showed that the levels of serum sFlt1 and PTEN were negatively correlated with FIGO stage (r=-0.689, -0.678, P<0.05), while the level of Gal-9 was positively correlated with FIGO stage (r=0.671, P<0.05). There were statistically significant differences in FIGO stage and depth of myometrial invasion between the good prognosis group and the poor prognosis group (P<0.05). Compared with patients in the good prognosis group, the levels of serum sFlt1 and PTEN in the poor prognosis group were significantly lower (P<0.05): sFlt1, (49.14±15.13) pg/mL vs (78.43±21.17) pg/mL;PTEN, (0.22±0.06) pg/mL vs (0.36±0.08) pg/mL;Gal-9 in the poor prognosis group were significantly higher (P<0.05): (36.40±7.12) ng/L vs (27.68±6.43) ng/L. Partial correla-tion analysis showed that serum sFlt1, PTEN, and Gal-9 were significantly correlated with 1-year prognosis in EC pa-tients (P<0.05). The area under the curve for the combined detection of serum sFlt1, PTEN, and Gal-9 for predicting 1-year prognosis in EC patients was 0.923, with a Youden's index of 0.707, a sensitivity of 84.85%, and a specificity of 85.88%. This combined detection of the three indexes was superior to each index alone in predicting 1-year prognosis (P<0.05). Conclusion The levels of serum sFlt1, PTEN, and Gal-9 in EC patients are closely related to FIGO staging and prognosis. The combined detection of sFlt1, PTEN, and Gal-9 can help improve the predictive value of 1-year prog-nosis for EC patients and provide a reference for clinical evaluation of disease outcomes.