| Objections:Our experiment is to discuss the relations between the levels in serum and expressions in endometria of EpCAM and CA125 and the development of endometrial adenocarcinoma (EAC) and endometrial intraepithelial neoplasia(EIN). At the same time, we investigate the value of serum levels of EpCAM and CA125 for diagnose and prognosis of EAC and EIN.Materials and Methods:74 samples of endometrial tissues with EAC, within which 26 samples of sera; 19 samples of endometrial tissues with EIN, within which 6 samples of sera; 54 samples of endometrial tissues as control group, within which 17 samples of sera (subgroup:17 samples of endometrial tissues with hyperplastic endometria, within which 5 samples of sera; 18 samples of endometrial tissues with secretory endometria, within which 6 samples of sera; 19 samples of endometrial tissues with atrophic endometria, within which 6 samples of sera). All these samples are tested by ELISA and IHC, and then the relationship between the levels in sera and expression in endometria of EpCAM and CA125 and the clinical information of patients/women is analyzed.Results:1,There are significantly differences in expression of EpCAM between EAC,EIN and subgroups(P<0.05), especially for atrophic endometrial.2,The positive cell number and proliferative degree of EpCAM and CA125 are statistically different between EA,EIN and subgroups(P<0.05).And there is correlationship between the positive cell number and proliferative degree of EpCAM and CA125 for each group.3,The expression of EpCAM is related with clinical-surgical stage and tumor size(P<0.05). As for the overexpression of EpCAM is related with cytological grade and muscular invasion depth and risk factor of EIN(P<0.05).4,The expression of CA125 is related with clinical-surgical stage and muscular invasion depth and cytological grade(P<0.05). As for the overexpression of CA125 is related with cytological grade and muscular invasion depth and risk factor of EIN(P<0.05).5,The relationship between serum levels of EpCAM in patients with normal endometria and EIN and EAC and clinical indexes:①he serum levels of EpCAM before surgery in control group,EIN and EAC are 3.12±2.66ng/ml,5.85±1.68ng/ml and 11.31±4.92ng/ml, with significantly statistical differences(P<0.05).②The serum levels of CA125 in pre-menopausal patients with EAC and normal endometria(8.31±2.88ng/ml,1.23±1.70ng/ml) are statistically different from post-menopausal patients(12.69±5.18ng/ml,4.67±2.31ng/ml) (P<0.05).③The serum levels of CA125 in patients with EAC and EIN and control group and hyperplastic endometria and secretory endometria and atrophic endometria are 7.41±3.81ng/ml,1.23±0.18ng/ml,1.52±0.89ng/ml,0.41±0.19ng/ml and 4.07±1.05ng/ml, with statistical differences(P<0.05).④The serum levels of EpCAM in EAC,EIN and control group after surgery are lower than before surgery. The serum levels of EpCAM in EAC and EIN before and after surgery are 11.31±4.92ng/ml,7.41±3.81ng/ml; 5.85±1.68ng/ml,1.22±0.27ng/ml, with significantly statistical differences(P<0.05).6,The relationship between serum levels of CA125 in patients with normal endometria and EIN and EAC and clinical indexes:①The serum levels of CA125 before surgery in control group,EIN and EAC are 22.59±9.23U/ml,28.18±15.89U/ml and 37.27±20.56U/ml, with significantly statistical differences(P< 0.05).②The serum levels of CA125 in pre-menopausal patients with EAC and normal endometria(49.77±27.40U/ml,25.40±8.01U/ml) are statistically different from post-menopausal patients(29.41±14.86U/ml,18.47±3.77U/ml) (P<0.05).③The serum levels of CA125 in patients with EAC and control group and hyperplastic endometria and secretory endometria after surgery are 25.90±12.40U/ml,16.99±9.38U/ml,11.73±2.26U/ml and 15.25±3.11U/ml, with statistical differences(P<0.05).④The serum levels of CA125 in EAC,EIN and control group after surgery are lower than before surgery. The serum levels of CA125 in EAC and hyperplastic endometria before and after surgery are 37.27±20.56U/ml,25.90±12.40U/ml; 18.89±4.05U/ml,11.73±2.26U/ml, with significantly statistical differences(P<0.05).7,The serum levels of EpCAM and CA125 have no correlation in endometrial cancer(P>0.05). So do the EIN and the control group.8,The significance in diagnosing EAC and EIN by testing serum levels of EpCAM and CA125 simultaneously or separately before surgery:①The sensitivity and specificity and accuracy and positive predictive palue for serum levels of EpCAM are higher than CA125. If combined, the sensitivity and accuracy could be improved.②For pre-menopausal patients the serum levels of EpCAM have better sensitivity and specificity and accuracy and positive predictive palue than CA125 before surgery in diagnosing EAC and EIN. If combined, the sensitivity could be improved.③For post-menopausal patients the serum levels of EpCAM have better specificity and accuracy and positive predictive palue than CA125 before surgery in diagnosing EAC and EIN. If combined, the sensitivity and accuracy could be improved.9,The significance in anticipating the prognosis of EAC by testing serum levels of EpCAM and CA125 simultaneously or separately before surgery:The serum levels of CA125 before surgery is related with patients'age, cytological grade and muscular invasion depth and clinical-surgical stage and tumor size. The serum levels of EpCAM before surgery is related with patients' age, clinical-surgical stage. The simultaneously positive of EpCAM and CA125 is related with muscular invasion depth and clinical-surgical stage. The simultaneously negative of EpCAM and CA125 is related with muscular invasion depth.Conclusions:1,There are increasing expression tendency of EpCAM and CA125 in EAC and EIN and control group. And this tendency is related with celluar proliferative degree. It suggests that the expression of EpCAM and CA125 may have a relationship with EAC.2,The serum levels of EpCAM and CA125 have a gradually increase tendency, which is coordinated with the expression in endometria and dramatically decrease after surgery in EIN and EAC, which is probably owing to EAC. It suggest us that endometria might be the main source of sera for patients with EAC and EIN.3,The serum levels of EpCAM are low for patients with secretory endometria, whereas EpCAM is overexpression in secretory endometria. We can predict that most of EpCAM and CA125 located in endomertria may lose, together with endometria which slough while mense.4,The serum levels of EpCAM are lower in secretory endometria than that other pathological and physiological endometria. And that may be the evidence for the inhibition of the growth of endometrial epithelia by progestogen and the mechanism of EAC. It also can help us find state which can not get EAC or EIN and monitor curative effect of progestogen.5,In patients with EAC,EIN and control group, the serum levels of EpCAM are higher in post-menopause than pre-menopause. To explain this phenomenon, we suppose that the degression of ovarian in function might be the reason for the increase of serum levels of EpCAM in post-menopausal patients.6,The serum levels of EpCAM have great probability to become one of independent biological indexes for diagnosing EAC and its precancerous lesion, especially for pre-menopause. What's more, the sensitivity of CA125 is better than that of EpCAM for pre-menopause. If combined, the sensitivity and accuracy in diagnosing EAC and EIN may be greatly enhanced.7,We could predict the prognosis of EIN by testing the expression of EpCAM and CA125.8,We could predict the prognosis of EIN by testing the serum levels of EpCAM and CA125 and both of them. |
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