In recent years, with the change of people's life and eating habits, the incidence of cervical cancer has been increasing year by year.(11) The main clinical picture of patients with cervical cancer are thin liquid discharge like water, earthy smell of leucorrhea, irregular vaginal bleeding, anemia, algopareunia and other clinical symptoms which have a serious impact on the patient's reproductive function and life safety and health].(12) Cervical cancer is also known as Invasive Carcinoma of Cervix. Cervical intraepithelial neoplasia is the early stage of cervical cancer, also known as Precancerous Lesion Phase.(13) According to clinical studies, patients with cervical cancer have a long Precancerous Lesion State, and it takes about 5–10 years to develop from cervical intraepithelial neoplasia to cervical cancer.(14) Therefore, early detection and diagnosis of cervical intraepithelial neoplasia and cervical cancer, and active treatment of precancerous lesions can effectively reduce the incidence and mortality of cervical cancer and improve the quality of life of patients with cervical lesions. In clinical screening and diagnosis of cervical cancer with vinegar white test combined with iodine test, colposcopy, HPV screening, cervical smear cytology, cervical and cervical tube biopsy, cervical conization screening.(15) The emergence of various screening technologies has improved the detection rate of clinical cervical cancer, but the screening costs of various screening methods are different, and the sensitivity and specificity are different. In recent years, with the development of clinical testing technology, the detection and diagnosis of cancer patients using molecular marker detection has gradually become a perspective study trend.
It was found that human SWI/SNF chromatin-remodeling complex consists of 9 ~ 12 subunits, and SMARCE1 was one of the subunits of human SWI/SNF chromatin remodeling complex.(16) The human SWI/SNF chromatin-remodeling complex contains one of the ATPases of the SMARCA4 or SMARCA4 and three major core subunits and other complex specific variant subunits. The subunits together played biological roles in regulating cell cycle progress, differentiation, DNA repair, activation, genomic instability, and programmed cell death.(17) Zhang Li, et al. (18) found that SMARCEI was a specific and sensitive marker of clear cell meningioma, and SMARCEI mutation could lead to the occurrence of clear cell meningioma. SMARCEI mutation causes the loss of SMARCEI function, leading to the loss of inhibition of SWI/SNF complex on tumor and participating in the occurrence and development of tumor.(19) The results of the study shown that the positive expression rates of SMARCE1 and CRISP3 in the observation group were significantly higher than the control group. It was indicated that SMARCEI was expressed in cervical cancer patients and the abnormal expression of SMARCEI maid participate in the occurrence and development of cervical cancer. The results of the study also found that the positive expression rate of SMARCE1 was statistically significant in different tumor differentiation degrees of cervical cancer patients, and the lower the tumor differentiation degree, the higher the positive expression rate of SMARCE1 and CRISP3 proteins. It was indicated that the abnormal expression of SMARCEI may have an impact on the pathological changes of cervical cancer and may play a key role in promoting the carcinogenesis and development of cervical cancer.
Human CRISP3 is located on human chromosome 6 and is the third member of the cysteine rich secretory protein family and is widely distributed in human tissues. It is detected in human body fluid secretion including sweat, plasma, prostate, pancreas and salivary glands.(20) The study found that CRISP3 is low expressed in colon, thymus, ovary and epididymis tissues, but its specific function has not been clearly studied.(21) CRISP3 is also low expressed in various tumor tissues that Henriksen R, et al.(22) found that CRISP3 is low expressed in malignant ovarian epithelial cells. Volpert M, et al. (23) found that CRISP3 can be used as a prognostic marker of prostate cancer. The higher the expression level of CRISP3 in prostate tissue, the higher the risk of recurrence of prostate cancer patients. WANG Y, et al. (24) found that the detection of CRISP3 level may be a new method to predict breast cancer. The low expression of CRISP3 in breast cancer patients is related to the overall survival rate and disease-free survival rate. The results of the study shown that the positive expression rate of CRISP3 in the observation group was significantly higher than the control group. It is indicated that CRISP3 is expressed in patients with cervical cancer and the abnormal expression of CRISP3 may participate in the occurrence and development of cervical cancer. The results of the study also shown that the positive expression rate of CRISP3 was statistically significant in different tumor differentiation degrees of cervical cancer patients, and the lower the tumor differentiation degree, the higher the positive expression rate of SMARCE1 and CRISP3 proteins. The abnormal expression of CRISP3 may have an impact on the pathological changes of cervical cancer, and may play a key role in promoting the carcinogenesis and development of cervical cancer.
Tumor markers refer to proteins, peptides or other biological substances are produced by the body in the process of tumor occurrence, development, invasion and metastasis of tumor cells which are synthesized, secreted or shed into body fluids or tissues by the tumor cells or the body in response to tumor cells.(25) The content of tumor markers in normal healthy people is extremely low, but it is obviously expressed at a high level in tumor tissues. Therefore, the determination of tumor markers presence or content could be used to diagnose the generation of malignant tumors, analyze the patient's condition, monitor metastasis, and judge the prognosis of patients.(26) CEA is an acid glycoprotein isolated from embryonic colon mucosa and colon adenocarcinoma which is expressed on the surface of tissue cell membrane and is widely used in the differential diagnosis of malignant tumors.(27) CA125 is a mucin-like glycoprotein with high molecular weight which can promote cell metastasis and infiltration by influencing mutual recognition and adhesion among cells.(28) CA153 is a polymorphic epithelial mucin secreted by glands and exists in many kinds of adenocarcinoma. Studies have found that the increase rate of CA153 can reach about 70% when tumor cells metastasize so that it has good diagnostic value for the development and prognosis of the disease.(29) The results of the study shown that the level of the serum CEA, CA125, CA153 in the observation group were significantly higher than the control group. It is indicated that CEA, CA125 and CA153 are highly expressed in cervical cancer patients, and the changes are related to the occurrence and development of cervical cancer.
In addition, the study results also found that the ROC curve analysis showed that the AUC values of SMARCE1, SMARCE1 + tumor markers, CRISP3, CRISP3 + tumor markers, SMARCE1 and CRISP3 combined tumor markers in the diagnosis of cervical cancer were 0.760, 0.851, 0.739, 0.810, 0.944, respectively. It is indicated that the combined detection of SMARCE1 and CRISP3 combined tumor markers has high clinical diagnostic value for cervical cancer. The study has the following deficiencies including only a small sample, single center study, and does not clarify how SMARCE1 and CRISP3 participate in the occurrence and development of cervical cancer. Large sample, multi-center studies are still needed in the future, and more in-depth biological research is needed to further clarify the relevant pathways.
To sum up, SMARCE1 and CRISP3 are expressed in cervical cancer patients, CEA, CA125 and CA153 are highly expressed in the serum of cervical cancer patients, and the combined detection of SMARCE1, CRISP3 and tumor markers has high clinical diagnostic value for cervical cancer.