摘要
目的 探讨宫颈癌子宫切除术患者组织中细胞分裂周期因子25A(CDC25A)和高迁移率族蛋白B1(HMGB1)蛋白表达对术后远期淋巴结转移的预测价值。方法 回顾性选取2017年1月至2019年12月于南阳市中心医院行子宫切除术治疗的350例宫颈癌患者作为训练集进行研究,并根据术后随访3年期间是否发生远期淋巴结转移分为转移组和非转移组。采用免疫组化检测患者CDC25A、HMGB1蛋白的表达,采用单因素分析和多因素logistic回归分析宫颈癌子宫切除术患者术后远期淋巴结转移的相关因素,采用受试者工作特征(ROC)曲线的线下面积(AUC)分析CDC25A、HMGB1蛋白单项及联合检测对术后远期淋巴结转移的预测价值。根据训练集与验证集7∶3的比例,另选取2020年1月至2021年6月于本院行子宫切除术治疗的150例宫颈癌患者作为验证集进行外部验证。结果 训练集350例宫颈癌子宫切除术患者术后远期淋巴结转移的有104例,发生率为29.71%。宫颈癌子宫切除术患者组织中CDC25A、HMGB1蛋白表达与FIGO分期、深肌层浸润、分化程度相关(P<0.05),与年龄、病理类型、肿瘤最大径无关(P>0.05)。多因素logistic回归分析结果显示,低分化程度、FIGO分期ⅠB2+ⅡA2期、肌层浸润深度>1/2肌层、CDC25A蛋白高表达、HMGB1蛋白高表示是宫颈癌子宫切除术患者术后发生远期淋巴结转移的独立危险因素(P<0.05)。训练集中CDC25A、HMGB1蛋白联合检测宫颈癌子宫切除术患者术后发生远期淋巴结转移的AUC为0.924(95%CI:0.898~0.951),明显高于CDC25A、HMGB1蛋白单项检测的AUC[0.869(95%CI:0.830~0.908)、0.859(95%CI:0.818~0.900)],差异均有统计学意义(Z=3.743,P<0.001;Z=4.276,P<0.001)。验证集中CDC25A、HMGB1蛋白联合检测宫颈癌子宫切除术患者术后发生远期淋巴结转移的AUC为0.933(95%CI:0.902~0.963),明显高于CDC25A、HMGB1蛋白单项检测的AUC[0.866(95%CI:0.820~0.912)、0.876(95%CI:0.829~0.924)],差异均有统计学意义(Z=3.615,P<0.001;Z=3.341,P=0.001)。结论 CDC25A、HMGB1蛋白高表达是宫颈癌子宫切除术患者术后发生远期淋巴结转移的独立危险因素,并与患者FIGO分期、深肌层浸润、分化程度有关,CDC25A、HMGB1蛋白联合检测对预测宫颈癌子宫切除术患者术后发生远期淋巴结转移有着较高的诊断价值。
Objective To investigate the predictive value of tissue cell division cycle factor 25A(CDC25A)and high mobility group box protein 1(HMGB1)expression for long-term lymph node metastasis in cervical cancer patients after hysterectomy.Methods A retrospective study was conducted on 350 cervical cancer patients who underwent hysterectomy at our hospital between January 2017 and December 2019.Patients were divided into metastasis(n=104)and non-metastasis(n=246)groups based on whether long-term lymph node metastasis occurred during the 3-year postoperative follow-up.Immunohistochemistry was used to detect the expression of CDC25A and HMGB1 in tumor tissues.Univariate and multivariate logistic regression analyses were performed to identify factors associated with long-term lymph node metastasis.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of CDC25A and HMGB1 expression,individually and in combination.Additionally,150 cervical cancer patients who underwent hysterectomy between January 2020 and June 2021 were selected as an external validation cohort in a 7∶3 training-to-validation ratio.Results Among the 350 patients in the training cohort,104(29.71%)experienced long-term lymph node metastasis.CDC25A and HMGB1 expression levels in tumor tissues were significantly associated with FIGO stage,deep muscle invasion,and differentiation degree(P<0.05),but were not related to age,pathological type,or tumor size(P>0.05).Multivariate logistic regression analysis identified low differentiation,FIGO stageⅠB2+ⅡA2,deep muscle invasion(>1/2),high CDC25A expression,and high HMGB1 expression as independent risk factors for long-term lymph node metastasis(P<0.05).In the training cohort,the area under the curve(AUC)for predicting long-term lymph node metastasis using the combined detection of CDC25A and HMGB1 was 0.924(95%CI:0.898-0.951),significantly higher than the AUCs for CDC25A(0.869,95%CI:0.830-0.908)or HMGB1(0.859,95%CI:0.818-0.900)alone(Z=3.743,P<0.001;Z=4.276,P<0.001).Similarly,in the validation cohort,the combined AUC was 0.933(95%CI:0.902-0.963),which was also significantly higher than the AUCs for CDC25A(0.866,95%CI:0.820-0.912)or HMGB1(0.876,95%CI:0.829-0.924)alone(Z=3.615,P<0.001;Z=3.341,P=0.001).Conclusion High expression of CDC25A and HMGB1 is an independent risk factor for long-term lymph node metastasis in cervical cancer patients after hysterectomy.Their expression is associated with FIGO stage,deep muscle invasion,and differentiation degree.The combined detection of CDC25A and HMGB1 has high diagnostic value for predicting long-term lymph node metastasis in cervical cancer patients after hysterectomy.
作者
徐小晶
王远航
徐燕
XU Xiao-jing;WANG Yuan-hang;XU Yan(Department of Gynecology,Nanyang Central Hospital,Nanyang 473000,Henan,China)
出处
《广东医学》
2025年第4期488-494,共7页
Guangdong Medical Journal
基金
河南省自然科学基金项目(182102311190)。
关键词
宫颈癌
子宫切除术
细胞分裂周期因子25A
高迁移率族蛋白1
远期淋巴结转移
预测价值
cervical cancer
hysterectomy
cell division cycle factor 25A
high mobility group box protein 1
long-term lymph node metastasis
predictive value
