Objective To investigate the value of secreted frizzled-related protein 1 (SFRP1), GATA binding protein 3 (GATA3) combined with human papillomavirus deoxyribonucleic acid (HPV-DNA) in predicting the risk of postoperative recurrence of high-grade cervical intraepithelial neoplasia (CIN) with positive thin-prep cytologic test (TCT).
Methods A total of 200 patients with high-grade CIN and positive TCT results from July 2021 to July 2023 were selected as study subjects. All patients underwent cervical conization, and were divided into recurrence group and non-recurrence group according to the recurrence status one year after surgery. The clinical data, HPV-DNA viral load, and the relative expression levels of SFRP1 mRNA and GATA3 mRNA in cervical tissues were compared between the two groups. The HPV-DNA viral load, SFRP1 mRNA, and GATA3 mRNA expression levels in patients with different CIN grades were compared, and their correlations with CIN grade and the risk of postoperative recurrence were analyzed. The predictive values of SFRP1, GATA3, and HPV-DNA for the risk of postoperative recurrence were analyzed.
Results Among 200 patients, 2 were lost during the follow-up period. The recurrence group (n=30) had higher proportions of CIN grade Ⅲ, glandular involvement, positive surgical margins, high-risk human papillomavirus (HPV), higher HPV-DNA viral load, and a higher proportion of HPV positivity at 6 months after surgery compared with the non-recurrence group (n=168), and the differences were statistically significant (P < 0.05). The relative expression levels of SFRP1 mRNA and GATA3 mRNA in cervical tissues of the recurrence group were lower than those of the non-recurrence group, and the differences were statistically significant (P < 0.001). The HPV-DNA level in patients with CIN grade Ⅲ was higher than that in those with CIN grade Ⅱ, and the relative expression levels of SFRP1 mRNA and GATA3 mRNA in cervical tissues were lower than those in patients with CIN grade Ⅱ, and the differences were all statistically significant (P < 0.001). Spearman correlation analysis showed that HPV-DNA was positively correlated with CIN grade (P < 0.001), while the relative expression levels of SFRP1 mRNA and GATA3 mRNA in cervical tissues were negatively correlated with CIN grade (P < 0.001). Logistic regression analysis showed that HPV-DNA, the relative expression levels of SFRP1 mRNA and GATA3 mRNA in cervical tissues were independent influencing factors for the risk of postoperative recurrence (P < 0.001). The receiver operating characteristic (ROC) curve results showed that the areas under the curve (AUCs) for predicting the risk of postoperative recurrence by HPV-DNA, the relative expression levels of SFRP1 mRNA and GATA3 mRNA in cervical tissues were 0.787, 0.781, and 0.764, respectively, with sensitivities of 80.00%, 76.67%, and 76.67%, and specificities of 74.40%, 73.81%, and 67.26%, respectively. The AUC for the combined prediction of the risk of postoperative recurrence by the three indicators was 0.924, with a sensitivity of 80.00% and a specificity of 93.45%, which was superior to the predictive values of each indicator alone (Z=3.159, 3.306, 4.018, P < 0.001).
Conclusion HPV-DNA, SFRP1, and GATA3 in cervical tissues have certain predictive values for the risk of postoperative recurrence in patients with high-grade CIN and positive TCT results, and combined detection can improve the predictive efficacy.
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