血清糖类抗原125与血管内皮生长因子联合检测对子宫内膜癌的诊断价值及临床意义
|
摘要
目的探讨血清糖类抗原125(CA125)与血管内皮生长因子(VEGF)在子宫内膜癌患者中的表达水平及二者联合检测在子宫内膜癌早期筛查中的临床意义。方法检测77例子宫内膜癌患者(子宫内膜癌组)、65例子宫良性病变患者(子宫良性病变组)和50例健康体检者(正常对照组)的血清的血清CA125、VEGF水平,并分析其相关性,探讨血清CA125、VEGF联合检测对子宫内膜癌的诊断价值。分析受试者工作特征(ROC)曲线,计算灵敏度、特异度和曲线下面积(AUC)等指标。结果子宫内膜癌组的血清CA125、VEGF水平均高于子宫良性病变组和正常对照组(P﹤0.05)。子宫内膜癌组患者的血清CA125与VEGF表达呈明显正相关(rs=0.544,P﹤0.01)。子宫内膜癌组患者的血清CA125、VEGF水平随着FIGO分期的增加而呈现升高趋势(P﹤0.01)。出现淋巴结转移子宫内膜癌患者的术前CA125、VEGF水平均明显高于未出现淋巴结转移的子宫内膜癌患者(P﹤0.01)。ROC曲线分析结果显示,CA125和VEGF联合检测的AUC为0.874(95%CI:0.818～0.929)。CA125和VEGF联合检测的灵敏度和准确度均明显高于单项指标检测(P﹤0.01)。结论血清CA125和VEGF对子宫内膜癌患者的早期筛查和诊断具有较高的应用价值,是鉴别子宫内膜良恶性病变的有效指标,二者在子宫内膜癌患者中存在明显相关性,通过联合检测可以提高对子宫内膜癌的检出率和准确度。
Objective To investigate the expression level of carbohydrate antigen 125(CA125) and vascular endothelial growth factor(VEGF) in endometrial carcinoma and the clinical significance of combined detection in early screening of endometrial carcinoma. Method The research included 77 cases with endometrial carcinoma(endometrial carcinoma group), 65 cases of benign uterine lesions(benign lesions group) and 50 cases of healthy volunteers(normal control group) as subjects, of which the serum level of CA125 and VEGF were analyzed, and their correlation was investigated,besides, the diagnostic value of combined detection of CA125 and VEGF for endometrial carcinoma was also discussed.Additionally, the receiver operating characteristic(ROC) curve was plotted, and the sensitivity, specificity as well as the area under the curve(AUC) were calculated. Result The serum level of CA125 and VEGF in endometrial carcinoma group were higher than those in benign lesions group and normal control group(P<0.05) and there was a positive correlation between serum CA125 and VEGF in patients with endometrial carcinoma(rs=0.544, P<0.01). The level of serum CA125 and VEGF tended to increaseas the FIGO stage elevated in endometrial carcinoma group(P<0.01). The level of CA125 and VEGF in patients with lymph node metastasis were significantly higher than those with nolymph node metastasis before surgery(P<0.01). ROC curve showed that the AUC of combined detection of CA125 and VEGF was 0.874(95% CI: 0.818-0.929). The sensitivity and accuracy of combined detection were significantly higher than those of each applied alone(P<0.01). Conclusion Serum CA125 and VEGF are highly applicable in the early screening and diagnosis of endometrial carcinoma, and it is an effective marker for differentiating benign and malignant endometrial lesions, besides, there is a clear correlation between them in the patients with endometrial carcinoma, and the combined detection may improve the detection rate and accuracy of endometrial carcinoma.
Objective To investigate the expression level of carbohydrate antigen 125(CA125) and vascular endothelial growth factor(VEGF) in endometrial carcinoma and the clinical significance of combined detection in early screening of endometrial carcinoma. Method The research included 77 cases with endometrial carcinoma(endometrial carcinoma group), 65 cases of benign uterine lesions(benign lesions group) and 50 cases of healthy volunteers(normal control group) as subjects, of which the serum level of CA125 and VEGF were analyzed, and their correlation was investigated,besides, the diagnostic value of combined detection of CA125 and VEGF for endometrial carcinoma was also discussed.Additionally, the receiver operating characteristic(ROC) curve was plotted, and the sensitivity, specificity as well as the area under the curve(AUC) were calculated. Result The serum level of CA125 and VEGF in endometrial carcinoma group were higher than those in benign lesions group and normal control group(P<0.05) and there was a positive correlation between serum CA125 and VEGF in patients with endometrial carcinoma(rs=0.544, P<0.01). The level of serum CA125 and VEGF tended to increaseas the FIGO stage elevated in endometrial carcinoma group(P<0.01). The level of CA125 and VEGF in patients with lymph node metastasis were significantly higher than those with nolymph node metastasis before surgery(P<0.01). ROC curve showed that the AUC of combined detection of CA125 and VEGF was 0.874(95% CI: 0.818-0.929). The sensitivity and accuracy of combined detection were significantly higher than those of each applied alone(P<0.01). Conclusion Serum CA125 and VEGF are highly applicable in the early screening and diagnosis of endometrial carcinoma, and it is an effective marker for differentiating benign and malignant endometrial lesions, besides, there is a clear correlation between them in the patients with endometrial carcinoma, and the combined detection may improve the detection rate and accuracy of endometrial carcinoma.
引文
[1] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132.
[2] Tzur T, Kessous R, Weintraub AY. Current strategies in the diagnosis of endometrial cancer[J]. Arch Gynecol Obstet,2017, 296(1):5-14.
[3] Jiang T, Huang L, Zhang S. Preoperative serum CA125:a useful marker for surgical management of endometrial cancer[J]. BMC Cancer, 2015, 15:396.
[4]潘姿女,叶柳青,丁金旺,等.血清癌抗原125和人附睾蛋白4在子宫腺肌症中的表达及临床意义[J].中华全科医学, 2014, 12(10):1645-1646; 1706.
[5] Presl J, Novotny Z, Topolcan O, et al. CA125 and HE4 levels in a Czech female population diagnosed with endometrial cancer in preoperative management[J]. Anticancer Res,2014, 34(1):327-331.
[6]刘婷婷,张淑香,高维萍.子宫内膜癌患者血清VEGF、IL-8、IL-24水平变化及意义[J].山东医药, 2012, 52(6):36-37.
[7] Ma X, Hui Y, Lin L, et al. Clinical significance of COX-2,GLUT-1 and VEGF expressions in endometrial cancer tissues[J]. Pak J Med Sci, 2015, 31(2):280-284.
[8]彭芝兰,魏丽惠,曹泽毅.子宫内膜癌.妇科常见肿瘤诊治指南(第3版)[M].北京:人民卫生出版社, 2010:43-65.
[9] Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium[J]. Int J Gynecol Obstet,2009, 105(2):103-104.
[10] Bast RC Jr, Feeney M, Lazarus H, et al. Reactivity of a monoclonal antibody with human ovarian carcinoma[J]. J Clin Invest, 1981, 68(5):1331-1337.
[11] Nikolaou M, Kourea HP, Tzelepi V, et al. The prognostic role of preoperative serum CA 125 levels in patients with endometrial carcinoma[J]. J BUON, 2014, 19(1):198-202.
[12] Powell JL, Hill KA, Shiro BC, et al. Preoperative serum CA-125 levels in treating endometrial cancer[J]. J Reprod Med, 2005, 50(8):585-590.
[13] Yildiz A, Yetimalar H, Kasap B, et al. Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 164(2):191-195.
[14] Wang XL, Pan ZM, Li AN, et al. Study on the correlation of Xinjiang endometrial tumor and vascular endothelial growth factor[J]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi, 2010, 24(2):98-100.
[15] Zhang J, Song H, Lu Y, et al. Effects of estradiol on VEGF and bFGF by Akt in endometrial cancer cells are mediated through the NF-κB pathway[J]. Oncol Rep, 2016, 36(2):705-714.
[16]曹世姣,张广亮,喻芳,等.子宫内膜癌中elF4E与VEGF的表达及其临床意义[J].中国癌症杂志, 2012, 22(2):120-124.
[17] Robati M, Ghaderi A, Mehraban M, et al. Vascular endothelial growth factor(VEGF)improves the sensitivity of CA125 for differentiation of epithelial ovarian cancers from ovarian cysts[J]. Arch Gynecol Obstet, 2013, 288(4):859-865.
[18]叶辉霞,李小毛,邓柳枝,等. CA125在子宫内膜癌诊断预测中的价值[J].广东医学, 2014, 35(16):2562-2563.
[19] Dobrzycka B, Mackowiak-Matejczyk B, Kinalski M, et al.Pretreatment serum levels of bFGF and VEGF and its clinical significance in endometrial carcinoma[J]. Gynecol Oncol, 2013, 128(3):454-460.
[20] Topolovec Z, Corusi?A, Babi?D, et al. Vascular endothelial growth factor and intratumoralmicrovessel density as prognostic factors in endometrial cancer[J]. Coll Antropol,2010, 34(2):447-453.
[21] Huang YW, Xu LQ, Luo RZ, et al. VEGF-c expression in an in vivo model of orthotopic endometrial cancer and retroperitoneal lymph node metastasis[J]. Reprod Biol Endocrinol, 2013, 11:49.
[22] Zhou X, Wang H, Wang X. Preoperative CA125 and fibrinogen in patients with endometrial cancer:a risk model for predicting lymphovascular space invasion[J]. J Gynecol Oncol, 2017, 28(2):e11.
[23]董动丽,顾劲松,赵绍杰.子宫内膜癌患者血清HE4、CA125水平变化及其意义[J].山东医药, 2017, 57(3):73-75.
[2] Tzur T, Kessous R, Weintraub AY. Current strategies in the diagnosis of endometrial cancer[J]. Arch Gynecol Obstet,2017, 296(1):5-14.
[3] Jiang T, Huang L, Zhang S. Preoperative serum CA125:a useful marker for surgical management of endometrial cancer[J]. BMC Cancer, 2015, 15:396.
[4]潘姿女,叶柳青,丁金旺,等.血清癌抗原125和人附睾蛋白4在子宫腺肌症中的表达及临床意义[J].中华全科医学, 2014, 12(10):1645-1646; 1706.
[5] Presl J, Novotny Z, Topolcan O, et al. CA125 and HE4 levels in a Czech female population diagnosed with endometrial cancer in preoperative management[J]. Anticancer Res,2014, 34(1):327-331.
[6]刘婷婷,张淑香,高维萍.子宫内膜癌患者血清VEGF、IL-8、IL-24水平变化及意义[J].山东医药, 2012, 52(6):36-37.
[7] Ma X, Hui Y, Lin L, et al. Clinical significance of COX-2,GLUT-1 and VEGF expressions in endometrial cancer tissues[J]. Pak J Med Sci, 2015, 31(2):280-284.
[8]彭芝兰,魏丽惠,曹泽毅.子宫内膜癌.妇科常见肿瘤诊治指南(第3版)[M].北京:人民卫生出版社, 2010:43-65.
[9] Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium[J]. Int J Gynecol Obstet,2009, 105(2):103-104.
[10] Bast RC Jr, Feeney M, Lazarus H, et al. Reactivity of a monoclonal antibody with human ovarian carcinoma[J]. J Clin Invest, 1981, 68(5):1331-1337.
[11] Nikolaou M, Kourea HP, Tzelepi V, et al. The prognostic role of preoperative serum CA 125 levels in patients with endometrial carcinoma[J]. J BUON, 2014, 19(1):198-202.
[12] Powell JL, Hill KA, Shiro BC, et al. Preoperative serum CA-125 levels in treating endometrial cancer[J]. J Reprod Med, 2005, 50(8):585-590.
[13] Yildiz A, Yetimalar H, Kasap B, et al. Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 164(2):191-195.
[14] Wang XL, Pan ZM, Li AN, et al. Study on the correlation of Xinjiang endometrial tumor and vascular endothelial growth factor[J]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi, 2010, 24(2):98-100.
[15] Zhang J, Song H, Lu Y, et al. Effects of estradiol on VEGF and bFGF by Akt in endometrial cancer cells are mediated through the NF-κB pathway[J]. Oncol Rep, 2016, 36(2):705-714.
[16]曹世姣,张广亮,喻芳,等.子宫内膜癌中elF4E与VEGF的表达及其临床意义[J].中国癌症杂志, 2012, 22(2):120-124.
[17] Robati M, Ghaderi A, Mehraban M, et al. Vascular endothelial growth factor(VEGF)improves the sensitivity of CA125 for differentiation of epithelial ovarian cancers from ovarian cysts[J]. Arch Gynecol Obstet, 2013, 288(4):859-865.
[18]叶辉霞,李小毛,邓柳枝,等. CA125在子宫内膜癌诊断预测中的价值[J].广东医学, 2014, 35(16):2562-2563.
[19] Dobrzycka B, Mackowiak-Matejczyk B, Kinalski M, et al.Pretreatment serum levels of bFGF and VEGF and its clinical significance in endometrial carcinoma[J]. Gynecol Oncol, 2013, 128(3):454-460.
[20] Topolovec Z, Corusi?A, Babi?D, et al. Vascular endothelial growth factor and intratumoralmicrovessel density as prognostic factors in endometrial cancer[J]. Coll Antropol,2010, 34(2):447-453.
[21] Huang YW, Xu LQ, Luo RZ, et al. VEGF-c expression in an in vivo model of orthotopic endometrial cancer and retroperitoneal lymph node metastasis[J]. Reprod Biol Endocrinol, 2013, 11:49.
[22] Zhou X, Wang H, Wang X. Preoperative CA125 and fibrinogen in patients with endometrial cancer:a risk model for predicting lymphovascular space invasion[J]. J Gynecol Oncol, 2017, 28(2):e11.
[23]董动丽,顾劲松,赵绍杰.子宫内膜癌患者血清HE4、CA125水平变化及其意义[J].山东医药, 2017, 57(3):73-75.