HE4结合CA125预测卵巢癌治疗预后的价值
|
摘要
目的探讨血清人附睾分泌蛋白4(serum human epididymis secretory protein 4,HE4)联合糖类抗原125(carbohydrate antigen 125,CA125)预测卵巢癌(ovarian cancer,OC)治疗预后的价值。方法选取笔者医院诊治的OC患者256例,随访4年。以患者复发、分期上升、淋巴结转移、死亡定义为终点事件并分组。比较分析两组患者的临床资料,将差异有统计学意义的结果进行COX多因素分析,运用ROC曲线进一步分析CA125、HE4对卵巢癌预后的预测能力。结果病灶直径(P=0. 023)、分化程度(P=0. 021)、分期(P=0. 014)、肌层浸润程度(P=0. 041)、HE4(P=0. 023)、CA125(P=0. 034)是影响预后的独立影响因素。根据ROC曲线得知,CA125预测卵巢癌预后的曲线下面积(area under curve,AUC)为0. 88,最佳诊断点为692. 53U/ml,其敏感度为64. 30%,特异性为93. 00%; HE4的AUC为0. 74,低于指标CA125,最佳诊断点为256. 05pmol/L,其敏感度为59. 20%,特异性为82. 90%。而CA125和HE4两者联合预测卵巢癌预后的AUC最高为0. 89。结论 CA125和HE4两者联合预测卵巢癌患者治疗后淋巴结转移敏感度高于两者单独检测,临床上可通过联合检测提高卵巢癌患者预后判断的准确性,及时制定医疗方案从而改善患者预后。
Objective To investigate the value of serum human epididymis secretory protein 4( HE4) combined with carbohydrate antigen 125( CA125) in predicting the prognosis of ovarian cancer( OC). Methods Totally 256 patients with ovarian cancer( ovarian cancer,OC) diagnosed and treated in our hospital were followed up for 4 years. Recurrence,staging,lymph node metastasis,and death were defined as end-point events and patients were defined as two groups according to end-point events. The clinical data of two groups of patients were compared and analyzed. COX multivariate analysis was performed with statistically significant results. ROC curves were used to further analyze the predictive power of CA125 and HE4 in the prognosis of ovarian cancer. Results Lesion diameter( P =0. 023),differentiation( P = 0. 021),pathological type( serous and mucinous),staging( P = 0. 014),myometrial infiltration( P =0. 041),HE4( P = 0. 023),CA125( P = 0. 034) were independent factors that affected the prognosis. According to the ROC curve,the area under curve( AUC) of CA125 predicting ovarian cancer prognosis was 0. 88. The best diagnostic point was 692. 53 U/ml. The sensitivity was 64. 30%,and the specificity was 93. 00%,The AUC of HE4 was 0. 74,lower than CA125. The best diagnostic point was256. 05 pmol/L. The sensitivity was 59. 20% and the specificity was 82. 90%. The highest AUC was the combination of CA125 and HE4( 0. 89). Conclusion The combination of CA125 and HE4 predicts the sensitivity of lymph node metastasis in patients with ovarian cancer after treatment is higher than that of the two separately. Clinically,the combination of CA125 and HE4 can improve the prognosis of patients with ovarian cancer and develop the medical plan in time to improve the prognosis of patients.
Objective To investigate the value of serum human epididymis secretory protein 4( HE4) combined with carbohydrate antigen 125( CA125) in predicting the prognosis of ovarian cancer( OC). Methods Totally 256 patients with ovarian cancer( ovarian cancer,OC) diagnosed and treated in our hospital were followed up for 4 years. Recurrence,staging,lymph node metastasis,and death were defined as end-point events and patients were defined as two groups according to end-point events. The clinical data of two groups of patients were compared and analyzed. COX multivariate analysis was performed with statistically significant results. ROC curves were used to further analyze the predictive power of CA125 and HE4 in the prognosis of ovarian cancer. Results Lesion diameter( P =0. 023),differentiation( P = 0. 021),pathological type( serous and mucinous),staging( P = 0. 014),myometrial infiltration( P =0. 041),HE4( P = 0. 023),CA125( P = 0. 034) were independent factors that affected the prognosis. According to the ROC curve,the area under curve( AUC) of CA125 predicting ovarian cancer prognosis was 0. 88. The best diagnostic point was 692. 53 U/ml. The sensitivity was 64. 30%,and the specificity was 93. 00%,The AUC of HE4 was 0. 74,lower than CA125. The best diagnostic point was256. 05 pmol/L. The sensitivity was 59. 20% and the specificity was 82. 90%. The highest AUC was the combination of CA125 and HE4( 0. 89). Conclusion The combination of CA125 and HE4 predicts the sensitivity of lymph node metastasis in patients with ovarian cancer after treatment is higher than that of the two separately. Clinically,the combination of CA125 and HE4 can improve the prognosis of patients with ovarian cancer and develop the medical plan in time to improve the prognosis of patients.
引文
1孙馥箐,段华.子宫内膜癌保留生育功能治疗的现状与存在的问题[J].中国微创外科杂志,2015,15(1):73-76
2 丁楠,李力.外周血微小RNA在卵巢上皮性癌早期诊断、预后评估及疗效监测中的作用[J].中华妇产科杂志,2017,52(1):68-70
3 刘海伦,程忠平. CA125不同计算方法在卵巢癌筛查、评估及预后方面的作用[J].现代妇产科进展,2016,25(8):636-639
4 於永爱,金仙玉. HE4、Sp1在上皮性卵巢癌中的表达及其临床意义[J].中国妇产科临床杂志,2016,5:391-394
5 Nassir M,Guan J,Luketina H,et al. The role of HE4 for prediction of recurrence in epithelial ovarian cancer patients-results from the OVCAD study[J]. Tumor Biol,2016,37(3):3009-3016
6 贾素娟,王治洁,张美琴,等.血清CA125、HE4和影像学检查在上皮性卵巢癌术后复发诊断中的应用价值[J].中国癌症杂志,2015,25(6):452-456
7 兰雪丽,贺昕红. DNA倍体分析技术在诊断妇科肿瘤中的研究进展[J].医学研究杂志,2017,46(5):15-17
8 Webb JR,Milne K,Kroeger DR,et al. PD-L1 expression is associated with tumor-infiltrating T cells and favorable prognosis in highgrade serous ovarian cancer[J]. Gynecol Oncol,2016,141(2):293-302
9 Yanjun QU,Zhao X,Dong L. Diagnostic value of peritoneal and lymph node metastasis of ovarian cancer by color doppler ultrasonagraphy[J]. J Prac Obstetr Gynecol,2010,26(8):605-608
10 包杰,闫昆,胡碧波.全腹多层螺旋CT扫描对卵巢癌分期术前评价中的价值[J].中华内分泌外科杂志,2016,10(1):63-66
11 王曙初,许海. CT和MRI在卵巢癌定性、分期、侵袭和转移诊断中的价值以及临床应用[J].中华临床医师杂志:电子版,2014(1):84-87
12 谢宏宇,王文杰,李贞子,等.卵巢癌脂质组学诊断标志物的筛选及其效果研究[J].中华肿瘤防治杂志,2016,23(23):1550-1555
13 陈仲波,朱笕青.卵巢癌筛查的研究进展[J].中国现代医生,2016,54(35):164-168
14 Liu L,Xu HX,Wang WQ,et al. Serum CA125 is a novel predictive marker for pancreatic cancer metastasis and correlates with the metastasis-associated burden[J]. Oncotarget,2016,7(5):5943-5956
15 徐丛剑,王宜生,杨子健. CA125在卵巢癌诊断中的应用困境与突破[J].中国实用妇科与产科杂志,2016,32(5):417-421
16 秦雪,刘鑫丽,王欣彦,等.血清CA125变化与上皮性卵巢癌预后及复发关系研究[J].中国实用妇科与产科杂志,2016,5:473-476
17 栾梅,梅雪绯,翟光宇,等.动态监测上皮性卵巢癌患者血清CA125水平对疗效及预后的评估价值[J].现代生物医学进展,2017,17(11):2080-2082
18 周子敬,胡元晶.血清HE4及CA125对子宫内膜癌宫外转移的预测价值[J].现代妇产科进展,2015,24(11):814-818
19 魏建国,许春伟.混合型上皮性卵巢癌的形态学及分子特征[J].临床与实验病理学杂志,2016,4:379
20 Leong HS,Galletta L,Etemadmoghadam D,et al. Efficient molecular subtype classification of high‐grade serous ovarian cancer[J]. J Pathol,2015,236(3):272-277
2 丁楠,李力.外周血微小RNA在卵巢上皮性癌早期诊断、预后评估及疗效监测中的作用[J].中华妇产科杂志,2017,52(1):68-70
3 刘海伦,程忠平. CA125不同计算方法在卵巢癌筛查、评估及预后方面的作用[J].现代妇产科进展,2016,25(8):636-639
4 於永爱,金仙玉. HE4、Sp1在上皮性卵巢癌中的表达及其临床意义[J].中国妇产科临床杂志,2016,5:391-394
5 Nassir M,Guan J,Luketina H,et al. The role of HE4 for prediction of recurrence in epithelial ovarian cancer patients-results from the OVCAD study[J]. Tumor Biol,2016,37(3):3009-3016
6 贾素娟,王治洁,张美琴,等.血清CA125、HE4和影像学检查在上皮性卵巢癌术后复发诊断中的应用价值[J].中国癌症杂志,2015,25(6):452-456
7 兰雪丽,贺昕红. DNA倍体分析技术在诊断妇科肿瘤中的研究进展[J].医学研究杂志,2017,46(5):15-17
8 Webb JR,Milne K,Kroeger DR,et al. PD-L1 expression is associated with tumor-infiltrating T cells and favorable prognosis in highgrade serous ovarian cancer[J]. Gynecol Oncol,2016,141(2):293-302
9 Yanjun QU,Zhao X,Dong L. Diagnostic value of peritoneal and lymph node metastasis of ovarian cancer by color doppler ultrasonagraphy[J]. J Prac Obstetr Gynecol,2010,26(8):605-608
10 包杰,闫昆,胡碧波.全腹多层螺旋CT扫描对卵巢癌分期术前评价中的价值[J].中华内分泌外科杂志,2016,10(1):63-66
11 王曙初,许海. CT和MRI在卵巢癌定性、分期、侵袭和转移诊断中的价值以及临床应用[J].中华临床医师杂志:电子版,2014(1):84-87
12 谢宏宇,王文杰,李贞子,等.卵巢癌脂质组学诊断标志物的筛选及其效果研究[J].中华肿瘤防治杂志,2016,23(23):1550-1555
13 陈仲波,朱笕青.卵巢癌筛查的研究进展[J].中国现代医生,2016,54(35):164-168
14 Liu L,Xu HX,Wang WQ,et al. Serum CA125 is a novel predictive marker for pancreatic cancer metastasis and correlates with the metastasis-associated burden[J]. Oncotarget,2016,7(5):5943-5956
15 徐丛剑,王宜生,杨子健. CA125在卵巢癌诊断中的应用困境与突破[J].中国实用妇科与产科杂志,2016,32(5):417-421
16 秦雪,刘鑫丽,王欣彦,等.血清CA125变化与上皮性卵巢癌预后及复发关系研究[J].中国实用妇科与产科杂志,2016,5:473-476
17 栾梅,梅雪绯,翟光宇,等.动态监测上皮性卵巢癌患者血清CA125水平对疗效及预后的评估价值[J].现代生物医学进展,2017,17(11):2080-2082
18 周子敬,胡元晶.血清HE4及CA125对子宫内膜癌宫外转移的预测价值[J].现代妇产科进展,2015,24(11):814-818
19 魏建国,许春伟.混合型上皮性卵巢癌的形态学及分子特征[J].临床与实验病理学杂志,2016,4:379
20 Leong HS,Galletta L,Etemadmoghadam D,et al. Efficient molecular subtype classification of high‐grade serous ovarian cancer[J]. J Pathol,2015,236(3):272-277
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |