早期子宫内膜癌患者术前血清人附睾蛋白4水平的前瞻性研究
Preoperative Serum Human Epididymis Protein 4 Levels in Early Stage Endometrial Cancer: A Prospective Study.
作者信息
Fanfani Francesco, Restaino Stefano, Cicogna Stefania, Petrillo Marco, Montico Marcella, Perrone Emanuele, Radillo Oriano, De Leo Rossella, Ceccarello Matteo, Scambia Giovanni, Ricci Giuseppe
机构信息
*Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara; †Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste; ‡Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome; and §Clinical Epidemiology and Public Health Research Unit, ∥Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
出版信息
Int J Gynecol Cancer. 2017 Jul;27(6):1200-1205. doi: 10.1097/IGC.0000000000001015.
OBJECTIVE
The aim of the study was to evaluate the prognostic value of human epididymis protein 4 (HE4) and cancer antigen 125 markers with pathological prognostic factor to complete the preoperative clinical panel and help the treatment planning.
METHODS
This prospective multicenter study was conducted in 2 gynecologic oncology centers between 2012 and 2014 (Institute for Maternal and Child Health IRCCS Burlo Garofolo in Trieste and Catholic University of the Sacred Heart in Rome, Italy). We enrolled 153 patients diagnosed with clinical early (International Federation of Gynecology and Obstetrics stages I-II) type I endometrial cancer.
RESULTS
Human epididymis protein 4 levels seemed to be strictly related to age (P < 0.001) and menopausal status (P < 0.002). Compared with myometrial invasion (MI), the HE4 values were significantly higher in case of invasion of greater than 50% of the thickness: MI of greater than 50%, median of 94.85 pmol/L (38.3-820.8 pmol/L), versus MI of less than 50%, median of 65.65 pmol/L (25.1-360.2 pmol/L), (P < 0.001). The HE4 levels increase significantly with increasing tumor size: diameter of larger than 2 cm, median of 86.9 pmol/L (35.8-820.8 pmol/L), versus diameter of smaller than 2 cm, median of 52.2 pmol/L (33.3-146.8 pmol/L), (P < 0.001). In our population, HE4 did not correlate with the histological grade, endometrial cancer type I versus type II (P = 0.86), the lymphovascular infiltration (P = 0.12), and the cervical invasion (P = 0.6). We established a new variable, considering 3 high-risk tumor features: MI of greater than 50% and/or histological G3 and/or type II. Human epididymis protein 4 levels significantly increase in high-risk tumors (high risk HE4, 93.6 pmol/L vs low-medium risk, 65.5 pmol/L; P < 0.001).
CONCLUSIONS
A preoperative HE4 evaluation could help stratify patients with deep invasion and/or metastatic disease and is correlated with other relevant prognostic factors to be considered to tailor an adequate surgical strategy.
目的
本研究旨在评估人附睾蛋白4（HE4）和癌抗原125标志物与病理预后因素的预后价值，以完善术前临床指标并辅助治疗方案的制定。
方法
这项前瞻性多中心研究于2012年至2014年在2个妇科肿瘤中心开展（意大利的里雅斯特市的IRCCS Burlo Garofolo妇幼保健研究所和罗马的圣心天主教大学）。我们纳入了153例被诊断为临床早期（国际妇产科联盟分期I-II期）的I型子宫内膜癌患者。
结果
人附睾蛋白4水平似乎与年龄（P<0.001）和绝经状态（P<0.002）密切相关。与肌层浸润（MI）相比，当浸润厚度大于50%时，HE4值显著更高：MI大于50%时，中位数为94.85 pmol/L（38.3 - 820.8 pmol/L），而MI小于50%时，中位数为65.65 pmol/L（25.1 - 360.2 pmol/L），（P<0.001）。HE4水平随肿瘤大小增加而显著升高：直径大于2 cm时，中位数为86.9 pmol/L（35.8 - 820.8 pmol/L），而直径小于2 cm时，中位数为52.2 pmol/L（33.3 - 146.8 pmol/L），（P<0.001）。在我们的研究人群中，HE4与组织学分级、I型与II型子宫内膜癌（P = 0.86）、淋巴血管浸润（P = 0.12）以及宫颈浸润（P = 0.6）均无相关性。我们设定了一个新变量，考虑3个高危肿瘤特征：MI大于50%和/或组织学G3级和/或II型。高危肿瘤中的人附睾蛋白4水平显著升高（高危组HE4为93.6 pmol/L，低 - 中危组为65.5 pmol/L；P<0.001）。
结论
术前HE4评估有助于对深部浸润和/或转移性疾病患者进行分层，并且与其他相关预后因素相关，可用于制定合适的手术策略。
Zotero 插件