Application Value Analysis Of Peripheral Blood Lymphocyte Subsets In Diagnosis Of Endometrioid Adenocarcinoma

Objective:The purpose of this study was to evaluate the application value of peripheral blood lymphocyte subsets detection in the diagnosis of endometrioid adenocarcinoma via exploring the differences in the levels of peripheral blood lymphocyte subsets in patients with endometrioid adenocarcinoma and non-cancer population,and analyzing the improvement effect of the detection of peripheral blood lymphocyte subsets on the risk prediction performance of the established nomogram model.Methods:Based on the clinical data(including age,height,weight,menopause,pregnancy history,complications,the ultrasonography in our hospital within 3 months before operation,the level of serum tumor markers within 3 months before operation,the level of blood lipid before operation,etc.)of 1493 patients(including 479 patients with endometrioid adenocarcinoma and 1014 non-cancer patients)in a single center,a basic nomogram model for predicting the risk of endometrial cancer was established.The clinical data of 257 patients newly diagnosed in gynecologic oncology department of Fujian Provincial Maternity and Children’s Hospital from October 2017 to October 2019 were collected prospectively based on the risk factors identified by nomogram,including 86 patients with endometrioid adenocarcinoma and 171non-cancer patients in the control group.The differences of peripheral blood lymphocyte subsets in different populations were detected and analyzed,and the clinical application potential of peripheral blood lymphocyte subsets detection was evaluated by using the Receiver Operating Characteristic Curve(ROC).Furthermore,combined with the basic nomogram model and using ROC analysis,Decision Curve Analysis(DCA),Net Reclassification Improvement(NRI),and Integrated Discrimination Improvement(IDI)analysis,the improvement of peripheral blood lymphocyte subsets detection on the basic nomogram model was investigated.A combined model was established and the advantages and disadvantages of different models were compared.Thereby,the value of peripheral blood lymphocyte subsets in the diagnosis of endometrioid adenocarcinoma was evaluated comprehensively.Results:1.The basic nomogram was established on the basis of eight independent risk factors obtained by multivariate logistic regression analysis: body mass index,menopause status,diabetes,hypertension,endometrial thickness,triglyceride,total cholesterol,HE4.Internal(c index 0.949)and external(c index 0.938)validation show that the basic nomogram is effective in predicting the risk of endometrioid adenocarcinoma.2.There was no significant difference in peripheral blood B lymphocytes,T lymphocytes,NK cells and CD8+T lymphocyte between patients with endometrioid adenocarcinoma and non-cancer patients(P>0.05).While there was significant difference in peripheral blood CD4+T lymphocyte levels between patients with endometrioid adenocarcinoma and non-cancer patients(P<0.001).Furthermore,there was a significant difference in peripheral blood CD4+T lymphocyte between patients with endometrial hyperplasia and patients with endometrioid adenocarcinoma(P=0.022),but there was no significant difference in peripheral blood CD4+T cells between patients with endometrial hyperplasia and patients without endometrial lesions(P>0.05).3.The ROC of CD4+T lymphocyte level for the diagnosis of endometrial cancer was constructed.The Area Under Curve(AUC)was 0.703.The cut-off value was41.3%,and the corresponding sensitivity and specificity were 68.6% and 64.3%,respectively.4.The AUC of the basic nomogram model was 0.938,and that of CD4+T lymphocyte combined with nomogram was 0.947 in the ROC analysis.Compared with the basic nomogram,combined with CD4+T lymphocyte detection can more accurately distinguish endometrioid adenocarcinoma and non-cancer cases(NRI continuous=0.561,95%CI: 0.312-0.810,P<0.001;NRI categorical=0.093,95%CI:0.008-0.178,P=0.030).The improvement of the discriminant performance reflected in patients with endometrial cancer rather than non-cancer patients(IDI=0.040,95%CI:0.018-0.062;P<0.001).Decision curve analysis showed that the combined of CD4+T lymphocyte detection and nomogram showed higher net income than the basic nomogram.Conclusion:There was a significant difference in the level of peripheral blood CD4+T lymphocyte subsets between patients with endometrioid adenocarcinoma and those without cancer,which has a certain value in the diagnosis of endometrioid adenocarcinoma.The establishment of a comprehensive prediction model based on the detection of peripheral blood CD4+T lymphocyte subsets and general clinical data may be used to evaluate the risk of endometrial cancer in hospital opportunistic screening population and guide clinical decision-making,but its clinical application needs more support in further research.