Expression of immune cell markers and tumor markers in patients with cervical cancer
Expression of immune cell markers and tumor markers in patients with cervical cancer
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宫颈癌患者免疫细胞标志物及肿瘤标志物的表达
DOI：
10.1136/ijgc-2020-001254
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发表时间：
2020-07-01
影响因子：
4.8
通讯作者：
Sun, Yunyan
中科院分区：
文献类型：
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作者：
Zhang, Liming;Zhang, Hui;Sun, Yunyan
目的宫颈癌是世界范围内最常见的癌症之一，免疫功能可能影响疾病的进展。血清标志物也可能与诊断和进展有关。本研究的目的是探讨外周血免疫细胞和血清肿瘤标志物水平对宫颈癌患者诊断和预后的临床价值。方法选取宫颈癌患者82例（早期组：IA-IB1和IIA1，局部晚期组：IB2和IIA2），宫颈上皮内瘤变（CIN）患者54例，健康女性54例（对照组）。纳入标准为：(1)经活检确定宫颈病变的患者；(2)未接受免疫治疗、化疗或放疗的患者。排除标准为：(1)有其他恶性肿瘤病史的患者；(2)心脏、肾脏等脏器功能衰竭的患者；(3)免疫性疾病患者；(4)孕妇或哺乳期妇女。检测免疫细胞及肿瘤标志物水平。分析组织病理因素之间的关系。评估不同程度宫颈病变（侵袭前病变或癌前病变）患者与健康女性免疫细胞和肿瘤标志物水平的相关性。结果对照组和CIN组宫颈鳞癌抗原、癌胚抗原水平均显著低于宫颈癌组（p<0.01）。早期和局部晚期淋巴结转移发生率分别为22.9%（11/48）和46.2%(12/26)，淋巴血管浸润阳性组和阴性组淋巴结转移发生率分别为58.8%（20/34）和7.5%(3/37)，差异有统计学意义（p<0.05）。早期组CD8+和CD8+ CD28+ T细胞水平明显低于CIN组和对照组（p=0.014, p=0.008）。宫颈癌组CD4+CD25+/CD4+比值显著高于对照组（p<0.01）。经logistic回归分析，血清鳞状细胞癌和癌胚抗原水平升高、CD4+CD25+/CD4+比值升高是宫颈癌的危险因素（p<0.05）。结论宫颈癌患者免疫功能较健康妇女和CIN患者有所下降，鳞状细胞癌和癌胚抗原水平升高。联合检测外周血免疫细胞和血清肿瘤标志物水平有助于宫颈癌患者的早期发现、诊断和预后评价。
Objective Cervical cancer is one of the most common cancers worldwide, and immune function may impact disease progression. Serum markers may also be associated with diagnosis and progression. The aim of this study was to explore the clinical usefulness of determining the levels of peripheral blood immune cells and serum tumor markers in predicting diagnosis and prognosis of patients with cervical cancer. Methods 82 patients with cervical cancer (early stage group: IA–IB1 and IIA1; locally advanced group: IB2 and IIA2), 54 patients with cervical intra-epithelial neoplasia (CIN), and 54 healthy women (control group) were recruited. Inclusion criteria were: (1) patients whose cervical lesions were determined based on biopsy; and (2) patients who had not undergone immunotherapy, chemotherapy, or radiotherapy. The exclusion criteria were as follows: (1) patients with a history of other malignant tumors; (2) patients with heart, kidney, and other organ failure; (3) patients with immune diseases; and (4) pregnant or lactating women. The levels of immunocytes and tumor markers were assayed. The relationships among histopathologic factors were analyzed. The correlation between the levels of immunocytes and tumor markers in patients with different degrees of cervical lesions (pre-invasive or cancer) and healthy women was evaluated. Results The squamous cell carcinoma antigen and carcinoembryonic antigen levels in the control group and the CIN group were significantly lower than those in the cervical cancer groups (p<0.01). The incidence of lymph node metastasis in the early stage and locally advanced groups were 22.9% (11/48) and 46.2% (12/26), respectively, and 58.8% (20/34) and 7.5% (3/37) in the positive and negative lymphovascular invasion groups, respectively (p<0.05). The levels of CD8+ and CD8+ CD28+ T cells in the early stage group were markedly lower than those in the CIN group and the control group (p=0.014, p=0.008, respectively). The ratio of CD4+CD25+/CD4+ in the cervical cancer groups was significantly higher than in the control group (p<0.01). The increased serum squamous cell carcinoma and carcinoembryonic antigen levels and CD4+CD25+/CD4+ ratio were risk factors for cervical cancer by logistic regression analysis (p<0.05). Conclusions In patients with cervical cancer, immune function was impaired compared with that in healthy women and patients with CIN, while squamous cell carcinoma and carcinoembryonic antigen levels were increased. Combined detection of the levels of peripheral blood immune cells and serum tumor markers may be helpful for early detection, diagnosis, and prognosis evaluation of patients with cervical cancer.