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Received:September 22, 2022 Published Online:July 19, 2023
Received:September 22, 2022 Published Online:July 19, 2023
中文摘要: 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联合临床病理参数对EC淋巴结转移的预测价值。方法 收集2018年6月至2022年6月于山西医科大学第一医院确诊并接受全面分期手术治疗的250例EC患者的临床资料进行回顾性分析，采用单因素和多因素logistic回归分析淋巴结转移的影响因素，绘制受试者工作特征曲线（ROC）判断相关指标预测EC患者淋巴结转移的能力。结果 单因素分析显示，术前人附睾蛋白4（HE4）、糖类抗原125（CA125）、糖类抗原 199（CA199）、癌胚抗原（CEA）、中性粒细胞与淋巴细胞比值（NLR）、Bokhman分型、组织学分级、病理类型、肌层浸润深度、肿瘤直径、宫颈间质浸润、宫旁受累、浆膜层受累、淋巴血管间隙浸润均与淋巴结转移有关（P＜0.05）。多因素logistic回归分析示，HE4≥85.650 pmol/L、CA125≥26.375 U/mL、NLR≥1.835、病理类型为非子宫内膜样癌、肌层浸润深度≥1/2、淋巴血管间隙浸润是EC淋巴结转移的独立危险因素（OR=1.004，1.007，1.728，5.778，4.090，4.114，P<0.05）。ROC曲线得出HE4、CA125、NLR、病理类型、肌层浸润、淋巴血管间隙浸润的阴性预测值均大于0.9；联合预测时，HE4+CA125+NLR+病理类型+肌层浸润深度+淋巴血管间隙浸润的曲线下面积最大（0.885），灵敏度最高（85.7%）。结论 HE4、CA125、NLR以及非子宫内膜样癌、肌层浸润深度、淋巴血管间隙浸润单独和联合检测对EC患者淋巴结转移状态进行预测均有较大价值，有助于临床实施个体化治疗。
中文关键词: 子宫内膜癌 淋巴结转移 中性粒细胞与淋巴细胞比值 人附睾蛋白4 糖类抗原125
Abstract:Objective To analyze the risk factors of lymph node metastasis(LNM) in endometrial carcinoma(EC) and to explore the predictive value of preoperative peripheral blood indexes combined with clinicopathological parameters for LNM in EC patients.
Methods A retrospective analysis was conducted on the clinical data of 250 EC patients diagnosed and treated with comprehensive staging surgery at the First Hospital of Shanxi Medical University from June 2018 to June 2022. The influencing factors of LNM were analyzed by using univariate and multivariate logistic regression analysis. The ability of preoperative relevant indicators in predicting LNM was judged by drawing receiver operating characteristic curves(ROCs).
Results Univariate analysis showed that preoperative levels of human epididymis protein 4(HE4), carbohydrate antigon(CA) 125, CA199, cancer embryo antigen(CEA), neutrophil-to-lymphocyte ratio(NLR), Bokhman typing, tumor histological grade, pathological type, myometrial invasion, tumor diameter, cervical interstitial invasion, parametrial involvement, serosal invasion and lymphovascular space infiltration were statistically related to LNM(P＜0.05). Multivariate logistic regression analysis showed that HE4≥85.650 pmol/L, CA125≥26.375 U/mL, NLR≥1.835, pathological type of non-endometrioid 〖JP3〗carcinoma, depth of myometrial infiltration≥1/2 and lymphovascular space infiltration were the independent risk factors of LNM in EC patients(OR=1.004, 1.007, 1.728, 5.778, 4.090, 4.114, P<0.05). ROC curve analysis showed that the negative predictive values of HE4, CA125, NLR, pathological type, myometrial invasion and lymphovascular space infiltration were all greater than 0.9. The combined prediction of HE4, CA125, NLR, pathological type, depth of muscle layer infiltration and lymphovascular space infiltration had the largest area under the curve(0.885) and the highest sensitivity(85.7%) in predicting LNM in EC patients.
Conclusion The individual and combined detection of HE4, CA125, NLR, non-endometrioid carcinoma, depth of myometrial infiltration and lymphovascular space infiltration have great value in predicting LNM status in EC patients, which is helpful for clinical individualized treatment.
keywords: Endometrial carcinoma Lymph node metastasis Neutrophil-to-lymphocyte ratio Human epldidymis protein 4 Carbohydrate antigen 125
文章编号： 中图分类号：R737.33 文献标志码：A
基金项目:山西省重点研发计划项目（201803D321001）
| Author Name | Affiliation |
| CHENG Lin*, ZHANG Sanyuan | *The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi 030000, China |
| 张三元2 | 2. 山西医科大学第一医院妇科，山西 太原 030000 |
| Author Name | Affiliation |
| CHENG Lin*, ZHANG Sanyuan | *The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi 030000, China |
| 张三元2 | 2. 山西医科大学第一医院妇科，山西 太原 030000 |
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