牡丹江医科大学学报

目的 检测Ⅰ型子宫内膜癌(endometrioid adenocarcinoma, EA)组织中miRNA Let-7的表达，并探讨其与患者临床病理特征及预后的关系；方法 选取我院2016年1月至2022年12月期间，经病理确诊和根治手术切除的EA患者59例作为病例组，及同期因子宫肌瘤或肌腺瘤切除的15例子宫组织作为对照组；收集肿瘤患者的临床病理参数及术后随访资料，实时荧光定量聚合酶链反应(qRT-PCR)法检测miRNA Let-7的表达以及在不同临床病理特征间的差异；采用Kaplan-Meier法分析不同miRNA Let-7表达水平与患者生存时间关系、Cox回归模型对影响EA预后的危险因素进行分析；结果 74例检测样本中，病例组的miRNA Let-7表达水平明显低于对照组，差异有统计学意义(t=3.232,P<0.05);且病例组中，复发患者的miRNA Let-7表达明显低于未复发患者；绘制miRNA Let-7预测EA发生的ROC曲线分析显示，当约登指数最大时，对应的miRNA Let-7值为0.831,其诊断灵敏度为0.881,特异度为0.95;EA患者中miRNA Let-7的表达与肿瘤的临床分期、肌层浸润、淋巴结转移及复发情况有关(均P<0.05);由Log-rank检验可见，临床分期、肌层浸润深度、淋巴结转移情况以及miRNA Let-7表达水平与患者的预后生存相关(均P<0.05);Kaplan-Meier生存曲线图可见miRNA Let-7低表达组的生存时间显著低于高表达组(P<0.05);多因素Cox风险分析结果显示，肿瘤的组织学级别、淋巴结转移以及miRNA Let-7表达水平是影响EA患者生存时间的独立危险因素。结论 miRNA Let-7的表达水平与Ⅰ型子宫内膜癌的恶性程度有关，并且是患者复发的独立危险因素，对于评估患者的预后复发具有较好的敏感度和特异度，有可能成为Ⅰ型子宫内膜癌鉴别诊断和复发的新标记物。

Objective To detect the expression of miRNA Let-7 in endometrioid adenocarcinoma(EA) tissues and explore its correlation with clinical pathological features and prognosis.Methods From January 2016 to December 2022, a total of 59 patients pathologically diagnosed with EA who underwent radical surgery were selected as the case group, and 15 normal uterine tissue samples of hysteromyoma or myoadenoma resection were used as control group. Clinicopathological parameters and postoperative follow-up data of tumor patients were collected. miRNA Let-7 expression levels were detected by quantitative real-time PCR(qRT-PCR) and the differences among different clinicopathological features were compared; Kaplan-Meier method was used to analyze the relationship between miRNA Let-7 expression level and the survival time, Cox regression model was used to analyze the risk factors affecting the prognosis of EA.Results Among the 74 samples tested, miRNA Let-7 expression level in case group was significantly lower than that in control group(t=3.232, P<0.05). Furthermore, the miRNA Let-7 expression of patients with recurrence was significantly lower than those without recurrence(P<0.05). The ROC curve analysis for the predictive value of miRNA Let-7 indicated that when the Youden index was maximized, the corresponding miRNA Let-7 value was 0.831, with a diagnostic sensitivity of 0.881 and a specificity of 0.95. In addition, the expression of miRNA Let-7 in EA was associated with tumor clinical stage, myometrial invasion, lymph node metastasis and recurrence(P<0.05). Log-rank test showed that clinical stage, depth of muscular infiltration, lymph node metastasis and miRNA Let-7 expression level were correlated with prognosis and survival(P<0.05) The Kaplan-Meier survival curve showed that the survival time of the miRNA Let-7 low expression group was significantly lower than that of the high expression group(P<0.05). Multivariate Cox risk analysis showed that tumor histological grade, lymph node metastasis and miRNA Let-7 expression level were independent risk factors for the survival time in EA patients. Conclusion The expression level of miRNA Let-7 is related to the malignancy grade of EA and is an independent risk factor for recurrence. It exhibits good sensitivity and specificity for evaluating the prognosis of patients, and may become a novel marker for the differentiation and recurrence of EA.