?;坻?,劉程程,梁美蓉,劉 暉,江 維,曾四元(.南昌大學(xué)研究生院醫(yī)學(xué)部03級(jí); .江西省婦幼保健院腫瘤科,南昌 330006)
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血清SCC-Ag水平與宮頸鱗癌ⅠB1期病理特征的關(guān)系
?;坻?,劉程程1,梁美蓉2,劉 暉2,江 維2,曾四元2
(1.南昌大學(xué)研究生院醫(yī)學(xué)部2013級(jí); 2.江西省婦幼保健院腫瘤科,南昌 330006)
目的 探討血清鱗狀細(xì)胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)水平與宮頸鱗癌ⅠB1期病理特征的關(guān)系。方法回顧性分析185例宮頸鱗癌ⅠB1期患者手術(shù)前后血清SCC-Ag水平與淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度、間質(zhì)侵犯的關(guān)系,并對(duì)其進(jìn)行相關(guān)性分析。結(jié)果185例患者有淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度≥1/2、有間質(zhì)侵犯的術(shù)前血清SCC-Ag水平均明顯高于無(wú)淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度<1/2、無(wú)間質(zhì)侵犯(均P<0.05),術(shù)前血清SCC-Ag水平與淋巴結(jié)轉(zhuǎn)移呈正相關(guān)(r=0.86,P<0.05)。結(jié)論宮頸鱗癌ⅠB1期患者術(shù)前血清SCC-Ag可用于評(píng)估淋巴結(jié)轉(zhuǎn)移情況。
宮頸鱗癌ⅠB1期; 鱗狀細(xì)胞癌抗原; 血清; 淋巴結(jié)轉(zhuǎn)移; 肌層浸潤(rùn)深度; 間質(zhì)侵犯
鱗狀細(xì)胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)是由Kato等[1]于1977年發(fā)現(xiàn)的腫瘤抗原TA-4中的一個(gè)片段,其相對(duì)分子質(zhì)量為48 000的糖蛋白。有研究[2-4]表明,血清SCC-Ag水平與宮頸鱗癌臨床分期、腫瘤大小、腫瘤擴(kuò)散、淋巴結(jié)轉(zhuǎn)移及預(yù)后相關(guān),因此目前血清SCC-Ag廣泛用于宮頸鱗癌的診斷及預(yù)后監(jiān)測(cè)中。為此,本研究探討血清SCC-Ag水平與宮頸鱗癌ⅠB1期病理特征的關(guān)系。
1.1 研究對(duì)象
選擇2013年1月至2014年12月江西省婦幼保健院腫瘤科收治的宮頸鱗癌ⅠB1期患者185例,年齡34~62(45.1±6.1)歲,病程3~545(96.4±11.6)d。均行廣泛性全子宮切除術(shù)+盆腔淋巴結(jié)清掃術(shù)+腹主動(dòng)脈旁淋巴結(jié)切除術(shù),均經(jīng)婦檢及病理確診為宮頸鱗癌ⅠB1期。其中有淋巴結(jié)轉(zhuǎn)移86例,無(wú)淋巴結(jié)轉(zhuǎn)移99例;肌層浸潤(rùn)深度≥1/2 88例,肌層浸潤(rùn)深度<1/2 97例;有間質(zhì)侵犯69例,無(wú)間質(zhì)侵犯116例。
1.2 研究方法
分析185例患者手術(shù)前后血清SCC-Ag水平與淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度和間質(zhì)侵犯的關(guān)系,并對(duì)其進(jìn)行相關(guān)性分析。
1.3 統(tǒng)計(jì)學(xué)方法
185例患者有淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度≥1/2、有間質(zhì)侵犯的術(shù)前血清SCC-Ag水平均明顯高于無(wú)淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度<1/2、無(wú)間質(zhì)侵犯(均P<0.05),有淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度≥1/2、有間質(zhì)侵犯的術(shù)后血清SCC-Ag水平與無(wú)淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度<1/2、無(wú)間質(zhì)侵犯比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。見(jiàn)表1。相關(guān)性分析結(jié)果顯示,術(shù)前血清SCC-Ag水平與淋巴結(jié)轉(zhuǎn)移呈正相關(guān)(r=0.86,P<0.05),術(shù)前血清SCC-Ag水平與肌層浸潤(rùn)、間質(zhì)侵犯均無(wú)相關(guān)性(r=0.18、0.37,均P>0.05)。
表1 185例患者手術(shù)前后血清SCC-Ag水平與病理特征的關(guān)系
宮頸癌是全球女性第二大常見(jiàn)惡性腫瘤,鱗癌為其主要病理類(lèi)型。早期宮頸鱗癌患者可以手術(shù)治療或放、化療,但行宮頸癌根治術(shù)治療后病理診斷存在淋巴結(jié)轉(zhuǎn)移、深肌層浸潤(rùn)及間質(zhì)侵犯等病理危險(xiǎn)因素時(shí)需補(bǔ)充放療或放、化療[5],因此尋找與病理危險(xiǎn)因素相關(guān)的生化指標(biāo)對(duì)患者選擇治療方案有重要的意義。SCC-Ag是鱗癌細(xì)胞所產(chǎn)生的一種特異性抗原,在鱗癌細(xì)胞中大量表達(dá)后釋放入血[6],因此在臨床中可通過(guò)檢測(cè)血清SCC-Ag水平來(lái)評(píng)估宮頸鱗癌患者病情及預(yù)后[7]。
曾艷等[8]研究認(rèn)為,宮頸癌灶浸潤(rùn)越深,腫瘤細(xì)胞質(zhì)中的SCC-Ag越易通過(guò)微血管,使血清中SCC-Ag水平升高。有研究[9-10]表明,宮頸鱗癌患者術(shù)前血清SCC-Ag水平與淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度及間質(zhì)侵犯均呈正相關(guān),并認(rèn)為術(shù)前血清SCC-Ag水平>3.5 μg·L-1是淋巴結(jié)轉(zhuǎn)移的高危因素。段律芳等[11]研究認(rèn)為,深肌層浸潤(rùn)及間質(zhì)侵犯是盆腔淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素。當(dāng)術(shù)前血清SCC-Ag水平>4.0 μg·L-1時(shí),淋巴結(jié)轉(zhuǎn)移的風(fēng)險(xiǎn)增加了近6.6倍。Lekskul等[12]研究認(rèn)為,血清SCC-Ag水平與腹主動(dòng)脈旁淋巴結(jié)轉(zhuǎn)移與否相關(guān)密切相關(guān)。本研究結(jié)果顯示,185例患者有淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度≥1/2、有間質(zhì)侵犯的術(shù)前血清SCC-Ag水平均明顯高于無(wú)淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度<1/2、無(wú)間質(zhì)侵犯(均P<0.05),有淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度≥1/2、有間質(zhì)侵犯的術(shù)后血清SCC-Ag水平與無(wú)淋巴結(jié)轉(zhuǎn)移、肌層浸潤(rùn)深度<1/2、無(wú)間質(zhì)侵犯比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),術(shù)前血清SCC-Ag水平與淋巴結(jié)轉(zhuǎn)移呈正相關(guān)(r=0.86,P<0.05),本研究結(jié)果與上述文獻(xiàn)報(bào)道基本一致。本研究結(jié)果還顯示,術(shù)前血清SCC-Ag水平與肌層浸潤(rùn)、間質(zhì)侵犯均無(wú)相關(guān)性(r=0.18、0.37,均P>0.05),可能與本文僅分析宮頸鱗癌ⅠB1期患者血清SCC-Ag水平有關(guān)。
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(責(zé)任編輯:胡煒華)
Relationship between Serum Levels of SCC-Ag and Pathological Features of Stage ⅠB1 Cervical Squamous Cell Carcinoma
ZHU Hui-ting1,LIU Cheng-cheng1,LIANG Mei-rong2,LIU Hui2,JIANG Wei2,ZENG Si-yuan2
(1.2013GradeofMedicalDepartmentofGraduateSchool,NanchangUniversity;
2.DepartmentofOncology,JiangxiProvinceMaternalandChildHealthHospital,Nanchang330006,China)
Objective To discuss the relationship between serum levels of squamous cell carcinoma antigen(SCC-Ag) and pathological features of stage ⅠB1 cervical SCC.Methods The relationships of serum SCC-Ag levels to lymph node metastasis,myometrial invasion depth and stromal invasion were retrospectively analyzed in 185 patients with stage ⅠB1 cervical SCC.Results Preoperative levels of serum SCC-Ag in patients with lymph node metastasis,myometrial invasion depth≥1/2 and stromal invasion were higher than those in patients with non-lymph node metastasis,myometrial invasion depth<1/2 and non-stromal invasion(P<0.05).Preoperative SCC-Ag levels were positively correlated with lymph node metastasis(r=0.86,P<0.05).Conclusion Preoperative serum levels of SCC-Ag can be used for the assessment of lymph node metastasis in patients with stage ⅠB1 cervical SCC.
stage ⅠB1 cervical squamous cell carcinoma; squamous cell carcinoma antigen; serum; lymph node metastasis; myometrial invasion depth; stromal invasion
2016-05-24
?;坻?1990—),女,碩士研究生,主要從事婦科腫瘤的診治研究。
曾四元,主任醫(yī)師,E-mail:Jacksonzeng@yeah.net。
R737.33; R446.1
A
1009-8194(2016)09-0030-03
10.13764/j.cnki.lcsy.2016.09.012