Objective: To evaluate the diagnostic and prognostic potential of preoperative serum steroid levels in endometrial cancer (EC) alone and in combination with clinical parameters and biomarkers CA-125 and HE4. Methods: This single-center observational study included 62 patients with EC and 70 controls with benign uterine conditions who underwent surgery between June 2012 and February 2020. Preoperative serum levels of classic androgens, 11-oxyandrogens, glucocorticoids and mineralocorticoids were measured using liquid chromatography–tandem mass spectrometry (LC-MS/MS). Machine learning was used to assess their diagnostic and prognostic value alone and combined with clinical parameters and tumor biomarkers. Results: Patients with EC had significantly higher serum levels of classic androgens (androstenedione, testosterone), 11-oxyandrogens (11β-hydroxy-androstenedione, 11β-hydroxy-testosterone) and glucocorticoids (17α-hydroxy-progesterone, 11-deoxycortisol) compared to controls. While individual steroids had limited diagnostic value, a multivariate model including classic androgens, CA-125, HE4, BMI and parity achieved an AUC 0.87, 79.1% sensitivity and 74.7% specificity in distinguishing EC from benign uterine condition. This model outperformed our previously published model based on CA-125, HE4 and BMI (AUC: 0.81,p< 0.0001). Prognostically, HE4 was the strongest marker for lymphovascular space invasion (LVSI) (AUC: 0.79) and deep myometrial invasion (MI) (AUC: 0.71). Among steroids, androstenedione was the most predictive of LVSI (AUC: 0.67), while 11β-hydroxy-testosterone was the strongest predictor of deep MI (AUC: 0.64). Conclusions: Patients with EC exhibit distinct steroid hormone profiles. While steroids alone offer modest diagnostic and prognostic value, integrating them into multivariate models improves diagnostic accuracy.
目的：评估术前血清类固醇水平单独及联合临床参数与生物标志物CA-125、HE4对子宫内膜癌（EC）的诊断和预后预测价值。方法：这项单中心观察性研究纳入2012年6月至2020年2月期间接受手术的62例EC患者及70例子宫良性疾病对照者。采用液相色谱-串联质谱法（LC-MS/MS）检测术前血清中经典雄激素、11-氧代雄激素、糖皮质激素和盐皮质激素水平。运用机器学习方法评估这些指标单独及联合临床参数与肿瘤标志物的诊断与预后价值。结果：与对照组相比，EC患者血清中经典雄激素（雄烯二酮、睾酮）、11-氧代雄激素（11β-羟基雄烯二酮、11β-羟基睾酮）及糖皮质激素（17α-羟基孕酮、11-脱氧皮质醇）水平显著升高。虽然单个类固醇诊断价值有限，但包含经典雄激素、CA-125、HE4、BMI和产次的多变量模型在区分EC与子宫良性疾病时获得AUC 0.87、敏感性79.1%、特异性74.7%的性能表现，优于我们既往发表的基于CA-125、HE4和BMI的模型（AUC：0.81，p<0.0001）。在预后预测方面，HE4是预测淋巴血管间隙浸润（LVSI）（AUC：0.79）和深肌层浸润（MI）（AUC：0.71）的最强标志物。在类固醇激素中，雄烯二酮对LVSI的预测能力最佳（AUC：0.67），而11β-羟基睾酮是深肌层浸润的最强预测因子（AUC：0.64）。结论：EC患者呈现特征性类固醇激素谱。虽然类固醇单独应用时诊断和预后价值有限，但将其纳入多变量模型可显著提升诊断准确性。
肿瘤(癌症)患者之家