Clinical Value of Vascular Cancer Thrombus and Myometrial Invasion Combined with Tumor Markers in Predicting Sentinel Lymph Node Metastasis of Endometrial Cancer

Jing Zhang, Yuan Zhang, Jingbo Liu, Mengjun Liu, Hongli Liu Department of Gynecologic Oncology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, 233004, People’s Republic of ChinaCorrespondence: Jing Zhang, Department of Gynecologic Oncology, First Affiliated Hospital of Bengbu Medical University, No. 287 Changhuai Road, Bengbu, Anhui, 233004, People’s Republic of China, Email [email protected]: To investigate the clinical value of vascular cancer thrombus and myometrial invasion combined with tumor markers (epididymal protein 4 (HE4), carbohydrate antigen 125 (CA125), carbohydrate antigen 153 (CA153), carbohydrate antigen 199 (CA199)) in predicting sentinel lymph node (SLN) metastasis of Endometrial Cancer (EC).Methods: A retrospective study was conducted on 150 patients with EC during January 2022 to December 2024. Patients were divided into a metastatic group of 32 cases and a non-metastatic group of 118 cases. The clinical data and tumor markers [HE4, carcinoembryonic antigen (CEA), CA125, CA153, CA199 and alpha fetoprotein (AFP)] levels were collected. Logistic regression analysis was used to identify the influencing factors of metastasis. The predictive value was evaluated by Receiver operating characteristic curve (ROC). Principal component analysis (PCA) was performed to analyze the distribution characteristics.Results: The incidence of vascular cancer thrombus (62.50%), the proportion of myometrial invasion ≥ 1/2 (90.63%) and serum levels of HE4, CA125, CA153 and CA199 in the metastatic group were significantly higher than those in the non-metastatic group (P< 0.05). Vascular cancer thrombus, myometrial invasion ≥ 1/2, HE4, CA153, CA125 and CA199 were all influencing factors of SLN metastasis of EC (P< 0.05). The AUC of the combined detection of vascular cancer thrombus, myometrial invasion, HE4, CA153, CA125 and CA199 was 0.904, with sensitivity and specificity of 85.59% and 84.38%, respectively. The combined detection has a high predictive value for SLN metastasis of EC. When the first principal component (PC1) was plotted against the second principal component (PC2), patients with SLN metastasis had significant disturbances in vascular cancer thrombus, myometrial invasion, HE4, CA153, CA125 and CA199. There were significant individual differences and dispersed distribution among EC groups, while patients without SLN metastasis could cluster well.Conclusion: The combined detection of vascular cancer thrombus, myometrial invasion combined with HE4, CA153, CA125 and CA199 can effectively predict SLN metastasis of EC. But these influencing factors had great fluctuation and uncertainty in patients with SLN metastasis of EC, which may be related to the complexity and heterogeneity of the disease.Keywords: vascular cancer emboli, myometrial invasion, tumor markers, endometrial cancer, sentinel lymph node metastasis