血清PAX8、ENO1、HE4、NRP-2联合检测在子宫内膜癌预后评估中的价值

doi:10.3969/j.issn.1006-5725.2026.12.007

Abstract

Abstract:

Objective To explore the relationships among Paired box 8 （PAX8）， α-enolase （ENO1）， human epididymal protein 4 （HE4）， and neuropilin-2 （NRP-2）， as well as their associations with the severity of endometrial cancer and their value in predicting the prognosis of patients. Methods From January 2021 to November 2022， 168 patients diagnosed with endometrial cancer were recruited， all of whom underwent surgical treatment. Following the surgical intervention， a follow-up protocol was initiated， requiring patients to attend follow-up appointments every three months. The follow-up period extended until November 2025. During this period， 3 patients were lost to follow-up. Ultimately， 165 patients with endometrial cancer were included in the study， forming the endometrial cancer group， with a median follow-up duration of 48 months. Among these patients， 35 cases with a poor prognosis （poor prognosis was defined as any occurrence of distant metastasis， patient death， or recurrence of endometrial cancer） were classified as the poor prognosis group， while the remaining 130 cases were designated as the good prognosis group. Concurrently， 165 patients with benign endometrial diseases were selected as the benign endometrial diseases group， and 165 healthy women were recruited as the healthy control group. Clinical data and serum levels of PAX8， ENO1， HE4， and NRP-2 were compared across the groups. The serum levels of PAX8， ENO1， HE4， and NRP-2 in relation to different pathological features were analyzed. The relationship between the serum levels of PAX8， ENO1， HE4， and NRP-2 and the severity of endometrial cancer was examined using Spearman correlation analysis. By designating patients with a poor prognosis as positive cases and those with a good prognosis as negative cases， the predictive value of the serum levels of PAX8， ENO1， HE4， and NRP-2 for the prognosis of patients with endometrial cancer was evaluated using the receiver's operating characteristics （ROC） curve. Results The serum levels of PAX8， ENO1， HE4， and NRP-2 in the endometrial cancer group were significantly higher than those in the benign endometrial disease group and the healthy control group. Additionally， the levels in the benign endometrial disease group were significantly higher than those in the healthy control group （P < 0.05）. In patients， the levels of serum PAX8， ENO1， HE4， and NRP-2 in those with FIGO stage Ⅲ-Ⅳ， poor differentiation， myometrial infiltration ≥ 1/2， and lymph node metastasis were significantly higher than those in patients with FIGO stage Ⅰ-Ⅱ， medium-high differentiation， myometrial infiltration < 1/2， and no lymph node metastasis （P < 0.05）. The serum levels of PAX8， ENO1， HE4， and NRP-2 were positively correlated with FIGO stage， myometrial infiltration， and lymph node metastasis， while negatively correlated with differentiation （P < 0.05）. The serum levels of PAX8， ENO1， HE4， and NRP-2 in patients with a poor prognosis were significantly higher than those in patients with a good prognosis （P < 0.05）. The combined detection of the serum levels of PAX8， ENO1， HE4， and NRP-2 could predict the area under the curve （AUC） of endometrial cancer patients， and this AUC value was higher than that of individual detection （P < 0.05）. Conclusions Serum levels of PAX8， ENO1， HE4， and NRP-2 are abnormally expressed in patients with endometrial cancer. This abnormal expression is closely related to the severity of the disease. Moreover， the combined examination of these markers has high clinical value in predicting the prognosis of patients with endometrial cancer.

Key words: endometrial carcinoma, severity of illness, antibody to gene 8 of pairing box, α-enolase, human epididymal protein 4, neuropilin-2, prognosis

CLC Number:

R737.33

Ting ZHU,Xiaowen ZONG,Yaping SUN,Zhaohui LUAN. Value of combined detection of serum PAX8， ENO1， HE4 and NRP-2 in prognosis evaluation of endometrial cancer[J]. The Journal of Practical Medicine, 2026, 42(12): 2136-2143.

Figures/Tables 7

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References 26

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指标	子宫内膜癌组（n = 165）	良性子宫内膜疾病组（n = 165）	健康对照组（n = 165）	F值	P值
年龄/岁	55.63 ± 6.15	54.93 ± 6.02	54.77 ± 6.59	0.881	0.415
BMI/（kg/m²）	24.96 ± 1.22	25.13 ± 1.35	25.11 ± 1.42	0.802	0.449

指标	子宫内膜癌组(n = 165)	良性子宫内膜疾病组(n = 165)	健康对照组(n = 165)	F值	P值
PAX8/(ng/mL)	58.14 ± 8.43	50.91 ± 7.46^?	41.32 ± 6.13^?#	214.495	< 0.001
ENO1/(pg/mL)	742.32 ± 88.46	472.49 ± 68.83^?	306.59 ± 41.09^?#	1 679.924	< 0.001
HE4/(pmol/L)	154.18 ± 15.24	139.11 ± 12.95^?	116.92 ± 7.05^?#	386.722	< 0.001
NRP-2/(μg/L)	17.12 ± 2.24	12.62 ± 1.32^?	4.78 ± 0.23^?#	4 649.318	< 0.001

指标	FIGO分期		t值	P值	分化程度		t值	P值
指标	Ⅰ—Ⅱ期	Ⅲ—Ⅳ期	t值	P值	低分化	中高分化	t值	P值
例数	108	57	-	-	29	136	-	-
PAX8/（ng/mL）	55.89 ± 7.90	62.41 ± 9.43	4.709	< 0.001	64.66 ± 9.51	56.75 ± 8.20	4.582	< 0.001
ENO1/（pg/mL）	725.41 ± 87.47	774.36 ± 90.33	3.380	0.001	771.91 ± 98.40	736.01 ± 86.34	1.983	0.049
HE4/（pmol/L）	146.38 ± 14.39	168.96 ± 16.85	9.026	< 0.001	163.98 ± 16.79	152.09 ± 14.91	3.812	< 0.001
NRP-2/（μg/L）	16.24 ± 1.96	18.79 ± 2.77	6.858	< 0.001	18.15 ± 2.71	16.90 ± 2.14	2.718	0.007
指标	肌层浸润		t值	P值	淋巴结转移		t值	P值
指标	< 1/2	≥ 1/2	t值	P值	有	无	t值	P值
例数	115	50	-	-	31	134	-	-
PAX8/（ng/mL）	54.75 ± 7.98	65.94 ± 9.46	7.815	< 0.001	64.24 ± 9.16	56.73 ± 8.26	4.468	< 0.001
ENO1/（pg/mL）	726.22 ± 86.88	779.35 ± 92.09	3.545	0.001	775.91 ± 91.01	734.55 ± 87.87	2.346	0.020
HE4/（pmol/L）	147.16 ± 14.87	170.32 ± 16.09	8.967	< 0.001	164.64 ± 16.84	151.76 ± 14.87	4.237	< 0.001
NRP-2/（μg/L）	16.30 ± 2.11	19.00 ± 2.54	7.090	< 0.001	18.42 ± 2.58	16.82 ± 1.16	5.267	< 0.001

指标	FIGO分期		分化程度		肌层浸润		淋巴结转移
指标	r值	P值	r值	P值	r值	P值	r值	P值
PAX8	0.695	< 0.001	-0.758	< 0.001	0.673	< 0.001	0.861	< 0.001
ENO1	0.836	< 0.001	-0.741	< 0.001	0.833	< 0.001	0.699	< 0.001
HE4	0.718	< 0.001	-0.689	< 0.001	0.799	< 0.001	0.763	< 0.001
NRP-2	0.739	< 0.001	-0.806	< 0.001	0.824	< 0.001	0.779	< 0.001

指标	预后不良组（n = 35）	预后良好组（n = 130）	t值	P值
PAX8/（ng/mL）	63.75 ± 9.31	56.36 ± 8.19	4.600	< 0.001
ENO1/（pg/mL）	778.83 ± 89.35	732.49 ± 88.22	2.751	0.007
HE4/（pmol/L）	178.99 ± 16.35	147.50 ± 14.94	10.847	< 0.001
NRP-2/ （μg/L）	18.94 ± 2.42	16.63 ± 2.19	5.416	< 0.001

Value of combined detection of serum PAX8， ENO1， HE4 and NRP-2 in prognosis evaluation of endometrial cancer

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指标	截断值	AUC	敏感度/%	特异度/%	P值	95%CI
PAX8	61.21 ng/mL	0.791	71.43	76.15	< 0.001	0.721 ~ 0.851
ENO1	748.42 pg/mL	0.729	74.29	66.15	< 0.001	0.654 ~ 0.795
HE4	155.27 pmol/L	0.788	77.14	68.46	< 0.001	0.717 ~ 0.848
NRP-2	17.92 ng/L	0.759	71.43	74.62	< 0.001	0.687 ~ 0.822
联合检查	-	0.885	94.29	71.31	< 0.001	0.826 ~ 0.929

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