The Different Types And Stages Of Folate Receptor Alpha Expression In Endometrial Carcinoma And Assessment On Its Diagnostic Performance

BackgroundEndometrial carcinoma(EC)is a malignant tumor which come from the endometrial epithelial cells.It is the second largest malignant tumor of the female genital system after cervical cancer.In recent years,with the emergence of non-normal hormone replacement therapy and obesity,diabetes and hypertension caused by the changes in people’s diet and living habits of life extension,The metabolic syndrome increased.Now endometrial carcinoma’s incidence has increased year by year and the trend is getting younger and younger.Now the exact etiology and pathogenesis is still not clear,so the study of endometrial carcinoma is urgently needed.At present we commonly use CA125 as an endometrial carcinoma screening marker,but its sensitivity and specificity are low.So it is of great significance to find a new tumor marker.Foreign studies have shown that folate receptor alpha(FRa)overexpression in about 90%of endometrial cancer tissues,and its expression is related to the staging and tumor differentiation,which is expected to become a new tumor marker,but the domestic on FRa and Endometrial cancer research rarely reported.However,whether FRa can replace CA125 or screening with CA125 for endometrial carcinoma has not been found in the latest literature.Therefore,on the basis of previous studies,the research group further explored and compared the expression of FRa and CA125 in tissues and serum,and evaluated the clinical diagnostic performance of FRa.As we all known,according to the clinical and pathological characteristics of endometrial carcinoma,it can be divided into two types.Type Ⅰ is estrogen dependent,Most of the type Ⅰ endometrial carcinomas are well differentiated and of low grade,and the prognosis is relatively good.Type Ⅱ is non estrogen dependent.It has high malignancy,poor differentiation and poor prognosis.Because of the extremely low incidence of type II endometrial cancer and difficult collection of cases,the research objects at home and abroad are endometrial cancer which have not been subdivided.However,whether FRa expression in the two types of endometrial cancer is different has an important significance for targeted therapy of FRa,so it needs to be clarified.In addition,the research group intends to further comparative analysis of the expression of FRa in endometrial cancer,in order to provide ideas that if it is possible to staging tumor via FRafluorescence imaging effect of endometrial cancer during the operation,and optimize the operation effect in the future.Objective:The sensitivity and specificity of FRa and CA125 were compared in serum and tissue to evaluate the diagnostic performance of FRa.Exploring the different types and stages of FRaexpression in endometrial carcinoma to provide ideas for the clinical application of FRa.Method:50 cases of endometrial carcinoma patients’ serum and 30 cases of normal patients’ serum and 143 cases of formalin fixed and paraffin embedded endometrial carcinoma tissue were collected.The 143 tissue cases include 30 cases of normal uterine tissue,83 cases of type Ⅰ endometrial carcinoma tissue(including stage Ⅰ、Ⅱ 43 cases,stage Ⅲ、Ⅳ 40 cases),30 cases of type Ⅱ endometrial carcinoma.The expression of serum FRA was detected by ELISA,and the expression of serum CA125 was detected by electrochemiluminescence.The expression of FRA and CA125 in tissues was detected by immunohistochemistry.Results:1/The analysis revealed serum FRa cut off value of 887.525pg/ml(AUC 0.775)and serum CA125cut off value of 42.57U/ml(AUC0.638)to predict endometrial malignancy.2/No mater in serum or tissues,The ROC curve between the levels of FRa and CA125 found that the area of the FRa’s ROC curve is larger than the CA125’s(AUC0.638).the sensitivity and specificity of FRa were higher than CA125,so FRa has a higher diagnostic value than CA125.In addition,The ROC curve showed that the combined serum FRa and CA125(AUC 0.809)was higher than that of a single serum FRa or CA125.3、The positive expression rate of FRa in type Ⅰ and type Ⅱ endometrial cancer tissues was significantly higher than that in normal endometrial tissues(P<0.05),and the difference was statistically significant.The high expression rate of FRa in type Ⅰ endometrial carcinoma tissue was higher than that in type Ⅱ endometrial carcinoma(P<0.05),the difference was statistically significant.4、The high expression rates of stage Ⅲ and Ⅳ FRa were higher than those in stage Ⅰ and Ⅱ in type Ⅱ endometrial carcinoma tissues,and the difference was statistically significant(P<0.05).Conclusion:1、No matter in serum or tissues,the sensitivity and specificity of FRa were higher than that of CA125,and the combined analysis of FRa and CA125 can improve the accuracy of diagnosis of endometrial carcinoma,suggesting that FRa may become a new tumor marker,screening endometrial carcinoma with CA125 in clinical application.2、The expression of FRa in different types of endometrial cancer is different,suggesting that there may be different pathogenesis.The high expression rate of FRa in type I endometrial cancer tissue is higher than that in type II endometrial cancer,suggesting that the targeted therapy of FRaof type I endometrial cancer is better in the future.3、The high expression rate of FRain Ⅲ and IV stage of type I endometrial carcinoma is higher than that in I and Ⅱ phase,which provides the possibility for the application of FRa targeted specific fluorescent developer in advanced endometrial carcinoma meticulous surgery to improve the curative effect.Which involves preliminarily staging by the depth and range of the fluorescence color,lymph node identification,and meticulous surgical margins.