术前血清SCCA对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值

doi:10.3969/j.issn.1000-8535.2022.06.006

摘要/Abstract

摘要： 目的分析术前血清鳞状细胞癌相关抗原(SCCA)对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值。方法选取2018年1月—2021年1月于我院肿瘤科治疗的128例宫颈鳞癌患者作为研究对象,根据其是否发生盆腔淋巴结转移将其分为转移组(42例)和非转移组(86例)。对比2组宫颈鳞癌患者一般资料,采用多因素Logistic分析宫颈鳞癌患者发生盆腔淋巴结转移的高危因素,采用ROC曲线评估术前血清SCCA对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值,通过约登指数确定最佳截断值。结果 2组患者一般资料对比,宫颈鳞癌细胞分化程度、宫颈鳞癌临床分期、宫颈鳞癌肿瘤直径大小、是否出现宫旁转移现象、是否出现脉管浸润现象、浸润深度、SCCA水平的差异有统计学意义,P<0.05;多因素Logistic分析显示宫颈鳞癌细胞分化程度、脉管浸润阳性、浸润深度、SCCA水平是宫颈鳞癌患者发生盆腔淋巴结转移的危险因素;ROC曲线分析结果显示,SCCA水平曲线下面积为0.909,最佳截断值为0.597 5 μg/L。结论术前血清SCCA水平对宫颈鳞癌患者发生盆腔淋巴结转移具有预测价值。

Abstract: Objective To analyze the predictive value of preoperative serum squamous cell carcinoma antigen (SCCA) on pelvic lymph node metastasis in patients with cervical squamous cell carcinoma.Methods A total of 128 patients with cervical squamous cell carcinoma treated in the oncology department of our hospital from January 2018 to January 2021 were selected as the research objects,and divided into metastatic group (42 cases) and non-metastatic group (86 cases) according to whether pelvic lymph node metastasis occurred.The general data of the two groups of patients with cervical squamous cell carcinoma were compared.Multivariate logistic analysis was used to analyze the risk factors for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma.ROC curve was used to evaluate the predictive value of preoperative serum SCCA for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma,and the optimal cut-off value was determined by Yoden index.Results When comparing the general data of the two groups of patients,the differences in the degree of cervical squamous carcinoma cell differentiation,clinical stage of cervical squamous carcinoma,tumor diameter of cervical squamous carcinoma,whether the phenomenon of parametastasis was present,whether the phenomenon of choroidal infiltration was present,depth of infiltration,and SCCA level were statistically significant,P<0.05; multi-factor logistic analysis showed that the degree of cervical squamous carcinoma cell differentiation,positive vascular invasion,depth of invasion and SCCA level were risk factors for pelvic lymph node metastasis in cervical squamous cell carcinoma patients.The results of ROC curve analysis showed that the area under the curve of SCCA level was 0.909 and the optimal cut-off value was 0.597 5 μg/L.Conclusions Preoperative serum SCCA level had good predictive value for the occurrence of pelvic lymph node metastasis in patients with cervical squamous carcinoma.

Key words: preoperative serum squamous cell carcinoma antigen, cervical squamous carcinoma, pelvic lymph node metastasis, predictive value

胡力, 林永汉, 胡家欢. 术前血清SCCA对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值[J]. 广州医药, 2022, 53(6): 27-30.

HU Li, LIN Yonghan, HU Jiahuan. Predictive value of preoperative serum SCCA level for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma[J]. Guangzhou Medical Journal, 2022, 53(6): 27-30.

参考文献

[1] 陈晓梅,陈世洪,王越希,等. 宫颈癌Ⅱ B期术前同期放化疗联合根治术与根治性放疗同期化疗疗效对比[J]. 武警后勤学院学报(医学版),2017,26(3):208-211.
[2] MAHARJAN M, TULADHAR H. Awareness and knowledge about screening tests for cervical cancer in patient attending obstetrics and gynaecology out patient department at a tertiary care hospital in Lalitpur[J]. Medical Journal of Shree Birendra Hospital, 2018, 17(2) : 12-18.
[3] 杨琳琳,王薇,张红平,等. 宫颈癌患者治疗前检测外周血细胞角蛋白19MRNA和鳞状细胞癌抗原的临床意义[J]. 中国老年学杂志,2017,37(8):1940-1941.
[4] ROTMAN J, HEEREN A M, GASSAMA A A, et al. Adenocarcinoma of the uterine cervix shows impaired recruitment of cDC1 and CD8⁺T cells and elevated beta-catenin activation compared with squamous cell carcinoma[J]. Clin Cancer Res,2020,26(14):3791-3802.
[5] 孔德强,李春静,盛修贵. 前哨淋巴结检测结果指导肿瘤＞2CM的Ⅰ B1期宫颈癌行广泛性宫颈切除术的临床研究[J]. 肿瘤学杂志,2016,22(12):998-1003.
[6] 左志超,张卫,邓文娟,等. MRI表观扩散系数值与相对表观扩散系数值对宫颈癌患者盆腔转移性淋巴结的诊断价值[J]. 广西医学,2017,39(5):606-609.
[7] 张洁,王艳萍,林瑞贞,等. 多B值磁共振扩散加权成像及动态增强扫描在宫颈癌临床分期及疗效评价中的初步研究[J]. 临床放射学杂志,2017,36(8):1150-1155.
[8] 吴秋珍,毛瑛玉,林茂华,等. APTIMA HPV E6/E7 MRNA 16,18/45基因型检测技术在宫颈癌前病变和宫颈癌筛查中的应用价值[J]. 诊断病理学杂志,2021,28(3):202-206.
[9] GRIGSBY P W, MASSAD L S, MUTCH D G, et al. FIGO 2018 staging criteria for cervical cancer: Impact on stage migration and survival[J]. Gynecol Oncol,2020,157(3):639-643.
[10] 李雪,伍艳平,周铁军,等. 宫颈鳞癌组织中miRNA-451、c-myc、E-cadherin、Vimentin的表达变化及其意义[J]. 山东医药,2020,60(36):46-49.
[11] 庄金满,卢婉婷,黄玉秀,等. 早期宫颈癌淋巴结转移的高危因素分析及列线图预测模型的构建[J]. 肿瘤防治研究,2019,46(1):50-54.
[12] VALENCIA-GUERRERO A, DRESSER K, CORNEJO K M. Utility of immunohistochemistry in distinguishing primary adnexal carcinoma from metastatic breast carcinoma to skin and squamous cell carcinoma[J]. Am J Dermatopathol,2018,40(6):389-396.
[13] 郑建军. 宫颈癌根治术后高危型人乳头瘤病毒、鳞状细胞癌抗原及鳞状细胞癌相关抗原检测对宫颈癌复发的预测价值[J]. 实用临床医药杂志,2019,23(23):58-60.
[14] 于岩岩,董越,董瑞彤,等. ⅠB1～Ⅱ A1期宫颈鳞癌盆腔淋巴结转移的相关因素分析及3.0T MR-DWI的预测价值[J]. 放射学实践,2017,32(4):325-327.
[15] 朱成功,姜继勇,张文清,等. 术前血清鳞状细胞癌抗原水平对早期宫颈鳞癌淋巴结转移的预测价值[J]. 现代妇产科进展,2020,29(12):896-900.
[16] 李兰,徐凡,胡辉权,等. 术前SCC-AG对早期宫颈鳞癌盆腔淋巴结转移预测价值研究[J]. 中国妇产科临床杂志,2021,22(1):3-5.
[17] 邵丹,朱峰. 宫颈癌患者血清鳞状细胞癌相关抗原、白细胞介素-6及转化生长因子水平变化及相关性[J]. 国际检验医学杂志,2018,39(4):432-434.
[18] WU M F, GUAN M M, LIU C H, et al. The added value of fasting blood glucose to serum squamous cell carcinoma antigen for predicting oncological outcomes in cervical cancer patients receiving neoadjuvant chemotherapy followed by radical hysterectomy[J]. Cancer Med,2019,8(11):5068-5078.