HE4、CA125及CA199在鉴别子宫内膜癌肌层浸润深度及病理分期中的临床应用价值

The clinical value of serum HE4, CA125 and CA199 in identifying the myometrial invasion depth and pathological stage of uterine corpus endometrial carcinoma

摘要:

目的： 探讨鉴别子宫内膜癌不同浸润深度及分期的血清分子标志物。方法： 检测212例子宫内膜癌患者血清人附睾蛋白E4（human epididymal protein E4，HE4）、癌胚抗原（carcinoembryonic antigen，CEA）、糖类抗原125（carbohydrate antigen 125，CA125）、糖类抗原199（carbohydrate antigen 199，CA199）、糖类抗原724（carbohydrate antigen 724，CA724）及甲胎蛋白（alpha fetoprotein，AFP）的表达水平，并分析其与病理参数之间的关系，进一步分析HE4、CEA、CA125、CA199、CA724及AFP在子宫内膜癌不同浸润深度及分期患者血清中的阳性表达率，计算各指标单独与联合诊断的灵敏度及特异度并绘制受试者工作特征（receiver operating characteristic，ROC）曲线比较诊断效能。结果： 血清HE4、CA125和CA199的表达水平和阳性率在子宫内膜癌浸润深度<1/2肌层与浸润深度≥1/2肌层组间，及FIGO分期Ⅰ/Ⅱ期与Ⅲ/Ⅳ期的组间，具有统计学差异。HE4+CA125+CA199在诊断浸润深度≥1/2及Ⅲ/Ⅳ期组中的灵敏度、特异度、准确率均相对较高。HE4+CA125+CA199联合诊断浸润深度≥1/2及Ⅲ/Ⅳ期的ROC曲线下面积均高于HE4单项诊断、CA125单项诊断、CA199单项诊断、HE4+CA125联合诊断、HE4+CA199联合诊断、CA125+CA199联合诊断。结论： 血清联合检测HE4、CA125及CA199表达量有助于鉴别预测子宫内膜癌浸润深度及较高分期。

Abstract:

Objective: To detect the serum molecular markers for diagnosing depth of tumor invasion and FIGO stage in endometrial carcinoma（EC）. Methods: The expression levels of human epididymal protein E4（HE4），carcinoembryonic antigen（CEA），carbohydrate antigen 125（CA125），carbohydrate antigen 199（CA199），carbohydrate antigen 724（CA724） and alpha fetoprotein（AFP） in 212 EC patients’ serum samples were measured and the correlation between them and pathological parameters was analyzed. The positive expression rates of HE4，CEA，CA125，CA199，CA724 and AFP in the serum were further analyzed，and the sensitivity，specificity and the receiver operating characteristic（ROC） curve were also calculated in each index alone and combined to compare diagnostic efficiency. Results: The expression level and positive rates of HE4，CA125 and CA199 in serum were statistically different between EC invasion depth < 1/2 myometrial and endometrial cancer invasion depth ≥ 1/2 myometrium，and were also different between FIGO stage Ⅰ/Ⅱ and Ⅲ/Ⅳ. The sensitivity，specificity and accuracy of HE4+CA125+CA199 in the diagnosis of invasion depth ≥ 1/2 and FIGO stage Ⅲ/Ⅳ were relatively higher. The area under the ROC curve of HE4+CA125+CA199 in diagnosing depth ≥ 1/2 and stage Ⅲ/Ⅳ were larger than that of HE4 single diagnosis，CA125 single diagnosis，CA199 single diagnosis，HE4+CA125 combined diagnosis，HE4+CA199 combined diagnosis and CA125+CA199 combined diagnosis. Conclusion: The combined detection of HE4，CA125 and CA199 in serum supports diagnosing the invasion depth more than a half and FIGO stage Ⅲ/Ⅳ and predicting high-risk factors of EC.