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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

31卷

期数:

2025年01期

页码:

72-77,92

栏目:

临床医学

出版日期:

2025-01-20

文章信息/Info

Title:

The relationship between serum tumor markers and pathological molecular markers of endometrial cancer and clinical pathological features

文章编号:

1006-8147(2025)01-0072-07

作者:

张艺珊; 杜 雪

（天津市人民医院妇科，天津 300121）

Author(s):

ZHANG Yishan;  DU Xue

（Department of Gynecology，Tianjin Union Medical Center，Tianjin 300121，China）

关键词:

子宫内膜癌; 肿瘤标志物; 病理特征; 免疫组化

Keywords:

endometrial cancer;  tumor markers;  pathological characteristics;  immunohistochemistry

分类号:

R737.3

DOI:

10.20135/j.issn.1006-8147.2025.01.0072

文献标志码:

A

摘要:

目的：探讨子宫内膜癌（EC）血清肿瘤标志物及病理分子标志物与临床病理特征的关系。方法：回顾性分析2018年1月—2024年2月天津市人民医院妇科收治的 144例原发性EC患者的术前血清肿瘤标志物糖类抗原（CA）125、CA199、CA72-4及术后组织病理分子标志物中雌激素受体 （ER） 、孕激素受体 （PR） 、抑癌基因 （P53） 、Ki-67与其病理类型、分期、分化程度、肌层浸润深度、淋巴脉管间隙浸润、宫颈间质浸润之间的关系。结果：国际妇产科联盟（FIGO，2009）EC手术-病理分期Ⅲ～Ⅳ期患者的CA125、CA199、CA72-4水平明显升高，差异有统计学意义（Z=-3.45、-4.10、-2.41，均P<0.05）。肌层浸润深度≥1/2的患者CA125水平明显升高，差异有统计学意义（Z=-2.02，P<0.05），CA125、CA199、CA72-4水平在子宫内膜样腺癌分化程度间比较差异有统计学意义（H=6.07、6.22、10.79，均P<0.05）。CA125、CA199、CA72-4联合用于FIGOⅢ～Ⅳ期、肌层浸润深度≥1/2诊断的曲线下面积（AUC）分别为 0.74、0.71。子宫内膜样腺癌ER、PR阳性表达率明显高于非子宫内膜样腺癌（χ2=26.84、26.47，均P<0.001）。EC Ⅰ～Ⅱ期ER、PR阳性表达率明显高于Ⅲ～Ⅳ期（χ2=18.81、12.66，均P<0.05）。高分化子宫内膜样腺癌ER、PR阳性表达率明显高于低分化子宫内膜样腺癌（χ2=18.04、12.62，均P<0.05）。肌层浸润深度＜1/2者ER、PR阳性表达率明显高于肌层浸润深度≥1/2者（χ2=13.17、12.32，均P<0.05）。无淋巴脉管间隙浸润、宫颈间质浸润者ER、PR阳性表达率明显高于有淋巴脉管间隙浸润、宫颈间质浸润者。P53突变型、Ki-67≥65%在组织病理类型间比较差异有统计学意义（χ2=27.13、8.43，均P<0.05），与子宫内膜样腺癌相比，非子宫内膜样腺癌中P53突变型及Ki-67 表达率明显升高。结论：CA125、CA199、CA724、ER、PR、P53、Ki-67与EC预后高危因素密切相关。

Abstract:

Objective： To explore the relationship between serum tumor markers and pathological molecular markers of endometrial cancer （EC） and their clinical pathological characteristics. Methods： A retrospective analysis was conducted on 144 cases of primary EC patients admitted in the Department of Gynecology， Tianjin Union Medical Center from January 2018 to February 2024 . The relationship between the preoperative serum tumor markers carbohydrate antigen（CA）125， CA199， CA72-4， as well as the postoperative tissue pa-thological molecular markers including estrogen receptor （ER）， progestin receptor （PR）， tumor suppressor gene （TP53）， Ki-67 and their pathological types， staging， degree of differentiation， depth of myometrial invasion， lymphovascular space invasion， and cervical stromal invasion were evaluated. Results： The levels of CA125， CA199， and CA72-4 in patients with stage Ⅲ-Ⅳ EC according to the International Federation of Gynecology and Obstetrics （FIGO， 2009） surgical-pathological staging were significantly elevated， with statistically significant differences（Z=-3.45， -4.10， -2.41， all P<0.05 ）. Patients with myometrial invasion depth of ≥1/2 had significantly elevated levels of CA125， with a statistically significant difference（Z=-2.02， P<0.05）. The level of CA125， CA199， and CA72-4 showed statistically significant differences among the differentiation grades of endometrioid adenocarcinoma（H=6.07，6.22，10.79， all P<0.05）. The area under the curve（AUC） for the combined use of CA125， CA199， and CA72-4 in diagnosing FIGO stages Ⅲ to Ⅳ， with a myometrial invasion depth of ≥1/2， were 0.74 and 0.71， respectively. The positive expression rates of ER and PR in endometrioid adenocarcinoma were significantly higher than those in non-endometrioid adenocarcinoma（χ2=26.84， 26.47， both P<0.001）. The positive expression rates of ER and PR in EC stages Ⅰ-Ⅱ were significantly higher than those in stages Ⅲ-Ⅳ（χ2=18.81， 12.66， both P<0.05）. The positive expression rates of ER and PR in well-differentiated endometrioid adenocarcinoma were significantly higher than those in poorly differentiated endometrioid adenocarcinoma （χ2=18.04， 12.62， both P<0.05）. The positive expression rates of ER and PR in patients with myometrial invasion depth less than 1/2 were significantly higher than in those with invasion depth of ≥1/2（χ2=13.17， 12.32， both P<0.05）. The positive expression rates of ER and PR in patients without lymphovascular space invasion， cervical stromal invasionwere significantly higher than in those with these conditions. The P53 mutation type and Ki-67 expression ≥65% showed statistically significant differences among tissue pathological types（χ2=27.13， 8.43， both P<0.05）， and compared to endometrioid adenocarcinoma， non-endometrioid adenocarcinoma had significantly higher rates of P53 mutation and Ki-67 expression. Conclusion： CA125， CA199， CA724， ER， PR， P53， and Ki-67 are closely related to the high-risk prognostic factors of EC.

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备注/Memo

备注/Memo:

作者简介：张艺珊（1993-），女，医师，硕士，研究方向：子宫内膜病变的临床与基础；通信作者：杜雪，E-mail：lanlandetommao@163.com。

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更新日期/Last Update: 2025-02-10