HPV分型、SCC-Ag与NLR联合对早期宫颈癌淋巴结转移的预测作用

马梅; 晋茂生; 叶国柳

doi:10.16766/j.cnki.issn.1674-4152.002404

HPV分型、SCC-Ag与NLR联合对早期宫颈癌淋巴结转移的预测作用

doi: 10.16766/j.cnki.issn.1674-4152.002404

蚌埠医学院第一附属医院妇产科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究重点项目 KJ2019A0343

详细信息

通讯作者:
晋茂生，E-mail：laomaojin@sina.com

中图分类号: R737.33 R730.43
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出版历程
- 收稿日期: 2021-02-22
- 网络出版日期: 2022-08-20

Predictive effect of HPV typing, SCC-Ag and NLR on lymph node metastasis of early cervical cancer

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

摘要

摘要: 目的探讨鳞状细胞癌抗原(SCC-Ag)、中性粒细胞与淋巴细胞比值(NLR)与早期宫颈鳞癌患者临床病理特征的相关性, 以及人乳头瘤病毒(HPV)分型、SCC-Ag、NLR联合对早期宫颈癌淋巴结转移的预测作用。方法选取2018年1月-2020年10月于蚌埠医学院第一附属医院术前常规行血清SCC-Ag及血常规检测的ⅠA2~ⅡA期宫颈鳞癌患者共302例, 其中明确HPV分型的共194例。对明确HPV分型的宫颈癌与淋巴结转移进行相关性分析, 对NLR及SCC-Ag与临床病理特征的相关性进行单因素及多因素分析; 绘制ROC曲线, 确定NLR及SCC-Ag对早期宫颈鳞癌淋巴结转移的最佳截断值, 以及联合诊断对早期宫颈癌淋巴结转移的预测作用。结果 194例确定HPV分型的患者中, HPV16阳性对淋巴结转移的灵敏度为52.94%, 特异度为27.50%。多因素分析结果显示, 肿瘤大小、肌层浸润深度、淋巴结转移状况是SCC-Ag滴度>2.0 ng/mL的独立影响因素, 淋巴结转移是NLR>1.753的独立危险因素。ROC曲线显示最佳截断值SCC为4.15 ng/mL、NLR为1.900, 联合诊断与临床病理诊断之间, 在检出阳性率上差异无统计学意义(χ²=0.03, P=0.869)。联合诊断时特异度为81.00%, 阳性似然比为45.71%, 阴性似然比为81.82%, 诊断效能相对较高。结论联合诊断对早期宫颈癌转移有一定的预测价值。
- 人乳头瘤病毒分型 /
- 鳞状细胞癌抗原 /
- 中性粒细胞与淋巴细胞比值 /
- 宫颈癌 /
- 淋巴结转移
Abstract: Objective To investigate the correlation between squamous cell carcinoma antigen (SCC-Ag), neutrophil to lymphocyte ratio (NLR) and clinicopathological characteristics of patients with early cervical squamous cell carcinoma, and discuss the predictive effect of HPV typing, SCC-Ag and NLR on lymph node metastasis of early cervical carcinoma. Methods A total of 302 patients with stageⅠA2-ⅡA cervical squamous cell carcinoma with serum SCC-Ag and routine blood tests before treatment in the First Affiliated Hospital of Bengbu Medical College from January 2018 to October 2020 were selected. Among them, 194 cases were identified with HPV type. The correlation between cervical cancer with HPV type and lymph node metastasis was analyzed. Univariate and multivariate analyses of the association between NLR and SCC-Ag and clinicopathological outcomes were performed in combination with patient-related cases. The ROC curve was drawn to determine the optimal truncation value of NLR and SCC-Ag for lymph node metastasis of early cervical squamous cell carcinoma, as well as the predictive effect of combined diagnosis on lymph node metastasis of early cervical carcinoma. Results Among 194 patients with HPV typing, the sensitivity and specificity of HPV16 positive for lymph node metastasis were 52.94% and 27.50%, respectively. Multivariate analysis showed that tumor size, invasion depth and lymph node metastasis were independent risk factors for SCC Ag titer>2.0 ng/mL, and lymph node metastasis was independent risk factor for NLR>1.753. ROC curve showed that the optimal cut-off value of SCC and NLR were 4.15 ng/mL and 1.900, respectively. There was no significant difference in positive rate between combined diagnosis and clinicopathological diagnosis (χ²=0.030, P=0.869). The specificity, positive likelihood ratio and negative likelihood ratio for combined diagnosis were 81.00%, 45.71% and 81.82%, respectively, which were relatively high. Conclusion Combined diagnosis has certain predictive value for early cervical cancer metastasis.
- Human papilloma virus types /
- Squamous cell carcinoma antigen /
- Neutrophil-lymphocyte ratio /
- Cervical cancer /
- Lymph node metastasis

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图 1 SCC-Ag、NLR预测早期宫颈鳞癌患者淋巴结转移的ROC曲线

Figure 1. Correlation analysis of HPV typing, SCC and NLR in the diagnosis of lymph node metastasis of early cervical cancer

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表 1 治疗前SCC-Ag及NLR与临床病理特征的单因素分析(例)

Table 1. Univariate analysis of SCC-Ag, NLR and clinicopathological characteristics before treatment (cases)

因素	例数	SCC-Ag		χ²值	P值	NLR		χ²值	P值
因素	例数	≤2.0 ng/mL	＞2.0 ng/mL	χ²值	P值	≤1.753	＞1.753	χ²值	P值
FIGO分期				18.334	＜0.001			4.636	0.098
ⅠA期	11	9	2			9	2
ⅠB期	204	117	87			100	104
ⅡA期	87	29	58			42	45
肿瘤大小(cm)				37.020	＜0.001			1.613	0.204
＜4	163	110	53			87	76
≥4	139	45	94			64	75
临床分级				0.423	0.809			0.227	0.893
Ⅰ~Ⅱ	21	12	9			11	10
Ⅱ	184	95	89			90	94
Ⅱ~Ⅲ	97	48	49			50	47
年龄(岁)				0.448	0.485			0.277	0.599
≤40	37	17	20			17	20
＞40	265	138	127			134	131
肌层浸润深度				47.628	＜0.001			5.025	0.025
＜1/2	94	76	18			56	38
＞1/2	208	79	129			95	113
盆腔淋巴结转移				14.213	＜0.001			4.669	0.031
有	72	23	49			28	44
无	340	132	98			123	107
脉管浸润				4.862	0.027			2.855	0.091
无	251	136	115			131	120
有	51	19	32			20	31
生长方式				18.000	＜0.001			1.295	0.523
外生型	58	31	27			27	31
内生型	208	94	114			103	105
其他型	36	30	6			21	15

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表 2 临床病理特征与术前SCC-Ag水平的多因素分析

Table 2. Multivariate analysis of clinicopathological features and preoperative SCC-Ag levels

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	-0.489	0.441	1.226	0.268	0.613	0.258~1.457
肿瘤直径	1.229	0.278	19.465	＜0.001	3.417	1.979~5.897
浸润深度	1.460	0.357	17.740	＜0.001	4.305	2.182~8.490
脉管浸润	0.005	0.392	< 0.001	0.991	1.005	0.466~2.166
淋巴结转移	0.703	0.338	4.338	0.037	2.021	1.042~3.917
临床分期	-2.517	1.224	4.225	0.040	0.081	0.007~0.890
生长方式	1.018	0.494	4.248	0.039	2.767	1.051~7.283
临床分级	0.022	0.614	0.001	0.972	1.022	0.307~3.402
注：变量赋值如下，年龄≤40岁=0，＞40岁=1；肿瘤直径＜4 cm=0，≥4 cm=1；浸润深度＜1/2=0，＞1/2=1；无脉管浸润=0，有脉管浸润=1；无淋巴结转移=0，有淋巴结转移=1。临床分级、生长方式、临床分期设哑变量赋值，分为变量1与变量2。Ⅰ~Ⅱ级=“变量1=1”、Ⅱ级=“变量2=1”、Ⅱ~Ⅲ级=“变量1与变量2=0”；外生型=“变量1=1”、内生型=“变量2=1”、其他型=“变量1与变量2=0”；ⅠA期“变量1=1”、ⅠB期=“变量2=1”、ⅡA期=“变量1与变量2=0”。

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表 3 HPV分型、SCC与NLR诊断早期宫颈癌淋巴结转移的相关分析

Table 3. Correlation analysis of HPV typing, SCC and NLR in the diagnosis of lymph node metastasis of early cervical cancer

项目	灵敏度(%)	特异度(%)	阳性似然比(%)	阴性似然比(%)
HPV分型	52.94	27.50	13.43	73.33
SCC-Ag	68.16	63.46	33.33	81.16
NLR	61.11	59.13	29.14	81.45
联合	47.06	81.00	45.71	81.82

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表 4 HPV分型、SCC-Ag及NLR联合诊断与早期宫颈癌淋巴结转移情况(例)

Table 4. HPV typing, SCC-Ag and NLR combined diagnosis and lymph node metastasis of early cervical cancer (cases)

联合诊断	淋巴结转移		合计
联合诊断	+	-	合计
+	16	19	35
-	18	81	99
合计	34	100	134

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