MRI联合CDK4、Ki-67对早期宫颈癌淋巴结转移的预测价值

游会婷; 晋茂生; 刘健

doi:10.16766/j.cnki.issn.1674-4152.003318

MRI联合CDK4、Ki-67对早期宫颈癌淋巴结转移的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003318

1.
蚌埠医学院第一附属医院妇产科，安徽蚌埠 233004
2.
蚌埠医学院第一附属医院肿瘤妇科

基金项目:

安徽省高校科学研究项目 KJ2019A0363

详细信息

通讯作者:
晋茂生, E-mail: 676926817@qq.com

中图分类号: R737.33 R730.4
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出版历程
- 收稿日期: 2023-09-02
- 网络出版日期: 2024-03-09

Predictive value of MRI combined with CDK4 and Ki-67 for lymph node metastasis in early cervical cancer

1.
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨MRI联合细胞周期蛋白依赖性激酶(CDK4)、Ki-67对早期宫颈癌淋巴结转移的预测价值。方法选取2020年12月—2022年10月在蚌埠医学院第一附属医院首次行宫颈癌根治术的患者101例，根据病理结果将其分为淋巴结转移组(LNM组)30例与非淋巴结转移组(NLNM组)71例。比较2组患者MRI淋巴结转移、肿瘤直径、间质浸润深度、宫旁及阴道受累情况、CDK4、Ki-67表达情况以及一般资料，多指标分析联合对早期宫颈癌淋巴结转移的预测价值。结果单因素分析显示：2组肿瘤直径、鳞状细胞癌抗原(SCC-Ag)、间质浸润深度、脉管浸润、MRI淋巴结转移、CDK4及Ki-67比较差异均有统计学意义(P＜0.05)。Logistic回归分析显示：肿瘤直径、SCC-Ag、间质浸润深度、Ki-67均为淋巴结转移的独立影响因素(P＜0.05)。CDK4、Ki-67、SCC-Ag及MRI的曲线下面积(AUC)分别为0.637、0.740、0.792、0.857；灵敏度分别为0.967、0.833、0.700、0.967, 特异度分别为0.282、0.592、0.845、0.634；SCC-Ag的最佳截断值为3.60 ng/mL, 约登指数为0.545；MRI联合SCC-Ag预测盆腔淋巴结转移的AUC为0.890，小于MRI联合CDK4、Ki-67联合诊断评估盆腔淋巴结转移的AUC(0.917)，小于多指标联合预测盆腔淋巴结转移的AUC(0.943，P＜0.05)。结论 MRI单独用于诊断宫颈癌淋巴结转移的灵敏度较低，CDK4的灵敏度较高但是不具有特异性，当MRI、CDK4、Ki-67三者联合时灵敏度和特异度均有明显提高，对于术前淋巴结转移具有预测价值。
- 宫颈癌 /
- 淋巴结转移 /
- 影像学 /
- 细胞周期蛋白依赖性激酶4 /
- Ki-67
Abstract: Objective To explore the predictive value of MRI combined with Cyclin-dependent kinase 4 (CDK4) and Ki-67 in predicting lymph node metastasis of early cervical cancer. Methods A total of 101 patients who were diagnosed with cervical cancer for the first time and underwent radical cervical cancer resection in the First Affiliated Hospital of Bengbu Medical College from December 2020 to October 2022 were selected and divided into lymphatic metastasis group (LNM group, n=30) and non-lymphatic metastasis group (NLNM group, n=71) according to pathological results. MRI lymph node metastasis, tumor diameter, stromal infiltration depth, uterine vagina involvement, CDK4, Ki-67 expression and general data were compared between the two groups. The prediction value of lymph node metastasis in early cervical cancer was analyzed. Results Single factor results showed that there were statistically significant differences in tumor diameter, SCC-Ag, depth of interstitial invasion, vascular invasion, MRI lymph node metastasis, CDK4 and Ki-67 (P < 0.05). Logistic regression analysis results showed that tumor diameter, squamous cell carcinoma antigen (SCC-Ag), depth of interstitial invasion and Ki-67 were independent risk factors for lymph node metastasis (P < 0.05). The area under the curve (AUC) of CDK4, Ki-67, SCC-Ag and MRI were 0.637, 0.740, 0.792 and 0.857, respectively. The sensitivity were 0.967, 0.833, 0.700, 0.967 and the specificity were 0.282, 0.592, 0.845, 0.634 respectively. The optimal cutoff value of SCC-Ag was 3.6 ng/mL, and the Jorden index was 0.545. The AUC of MRI combined with SCC-Ag in predicting pelvic lymph node metastasis was 0.890, which was smaller than the AUC of MRI combined with CDK4 and Ki-67 in evaluating pelvic lymph node metastasis (0.917), and smaller than the AUC of multiple indicators combined in predicting pelvic lymph node metastasis (0.943, P < 0.05). Conclusion MRI alone has low sensitivity in the diagnosis of cervical cancer lymph node metastasis, while CDK4 has high sensitivity but no specificity. When MRI, CDK4 and Ki-67 are combined, both sensitivity and specificity are significantly improved, which has predictive value for preoperative lymph node metastasis.
- Cervical cancer /
- Lymph node metastasis /
- Imaging /
- Cyclin-dependent kinase 4 /
- Ki-67

HTML全文

图 1 2组CDK4、Ki-67表达情况(免疫组化，×200)

注：A为CDK4在淋巴结转移组中的表达；B为CDK4在非淋巴结转移组中的表达；C为Ki-67在淋巴结转移组中的表达；D为Ki-67在非淋巴结转移组中的表达。

Figure 1. Immunohistochemical expression of CDK4 and KI-67 in the two group (Immunohistochemistry, ×200)

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图 2 各指标及多指标联合诊断宫颈癌淋巴结转移的ROC曲线

Figure 2. Receiver operating characteristic curve of each index and multi-index combination

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表 1 影响盆腔淋巴结转移的单因素分析

Table 1. Single-factor analysis of the risk factors affecting pelvic lymph node metastasis

项目	淋巴结转移		统计量	P值
项目	是(n=30)	否(n=71)	统计量	P值
年龄(x±s，岁)	51.13±10.99	54.23±11.46	-1.254^a	0.213
肿瘤直径[M(P₂₅, P₇₅), cm]	4.30(3.68, 5.25)	2.70(1.90, 3.50)	-5.651^b	＜0.001
临床分期[例(%)]			-0.885^b	0.376
ⅠA	0	4(5.6)
ⅠB	18(60.0)	43(60.6)
ⅡA	12(40.0)	24(33.8)
SCC-Ag[M(P₂₅, P₇₅), ng/mL]	6.10(2.15, 7.60)	1.70(1.10, 2.91)	-4.620^b	＜0.001
间质浸润深度[例(%)]			25.345^c	＜0.001
＜1/2	3(10.0)	46(64.8)
≥1/2	27(90.0)	25(35.2)
分化程度[例(%)]			-0.901^b	0.368
Ⅰ	0	1(1.4)
Ⅱ	19(63.3)	50(70.4)
Ⅱ~Ⅲ	5(16.7)	9(12.7)
Ⅲ	6(20.0)	11(15.5)
肿瘤内/外生[例(%)]			0.518^c	0.472
内	24(80.0)	52(73.2)
外	6(20.0)	19(26.8)
脉管浸润[例(%)]			9.151^c	0.002
有	19(63.3)	22(31.0)
无	11(36.7)	49(69.0)
宫旁及阴道壁受累[例(%)]			0.149^c	0.699
是	4(13.3)	6(8.5)
否	26(86.7)	65(91.5)
病理类型[例(%)]			0.821^c	0.365
鳞癌	26(86.7)	67(94.4)
腺癌	4(13.3)	4(5.6)
MRI淋巴结转移[例(%)]			5.892^c	0.015
是	10(33.3)	9(12.7)
否	20(66.7)	62(87.3)
CDK4[例(%)]			-2.284^b	0.022
-	1(3.3)	20(28.2)
+	14(46.7)	28(39.4)
++	9(30.0)	11(15.5)
+++	6(20.0)	12(16.9)
Ki-67[例(%)]			-3.933^b	＜0.001
-	1(3.3)	21(29.6)
+	4(13.3)	21(29.6)
++	11(36.7)	15(21.1)
+++	14(46.7)	14(19.7)
注：^a为t值, ^b为Z值, ^c为χ²值。

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表 2 影响盆腔淋巴结转移的多因素分析

Table 2. Multivariate analysis of factors influencing pelviclymph node metastasi

变量	B	SE	Waldχ²	P值	OR(95% CI)
肿瘤直径	0.730	0.349	4.381	0.036	2.075(1.048~4.109)
SCC-Ag	0.182	0.092	3.912	0.048	1.199(1.002~1.436)
间质浸润深度	1.947	0.866	5.057	0.025	7.007(1.284~38.234)
脉管浸润	0.665	0.719	0.857	0.355	1.945(0.476~7.955)
MRI淋巴结转移	1.200	0.900	1.775	0.183	3.319(0.568~19.389)
CDK4	0.160	0.414	0.149	0.699	1.173(0.521~2.643)
Ki-67	0.872	0.400	4.753	0.029	2.393(1.092~5.243)
注：变量赋值如下，肿瘤直径、SCC-Ag以实际值赋值；脉管浸润，有=1，无=0；MRI淋巴结转移，有=1，无=0；间质浸润深度，＜1/2=1，≥1/2=2；CDK4表达，阴性=1，(+)=2，(++)=3，(+++)=4；Ki-67表达，阴性=1，(+)=2，(++)=3，(+++)=4。

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表 3 各指标及多指标联合对宫颈癌淋巴结转移的预测情况

Table 3. Prediction of lymph node metastasis of cervical cancer by each index and multiple indexes combined

项目	AUC(95% CI)	灵敏度	特异度	阳性预测值(%)	阴性预测值(%)	P值
多指标联合	0.943(0.896~0.989)	0.967	0.873	76.3	98.4	＜0.001
MRI、CDK4与Ki-67联合	0.917(0.864~0.971)	0.967	0.789	65.9	98.2	＜0.001
MRI与SCC-Ag联合	0.890(0.829~0.951)	0.900	0.789	64.3	94.9	＜0.001
MRI	0.857(0.786~0.927)	0.967	0.634	52.7	97.8	＜0.001
SCC-Ag	0.792(0.690~0.894)	0.700	0.845	65.6	87.0	＜0.001
Ki-67	0.740(0.641~0.839)	0.833	0.592	46.3	89.4	＜0.001
CDK4	0.637(0.528~0.747)	0.967	0.282	36.3	95.2	0.030

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