卵巢癌患者肿瘤细胞减灭术后复发的影响因素

陈燕荣; 武明娟; 刘冰; 赵敏

doi:10.7619/jcmp.20220748

卵巢癌患者肿瘤细胞减灭术后复发的影响因素

陈燕荣¹,
武明娟^2, ,,
刘冰³,
赵敏²

1.
中国航天科技集团公司七三八疗养院妇科, 江苏无锡, 214000
2.
江苏省无锡市妇幼保健院妇科, 江苏无锡, 214000
3.
黑龙江省哈尔滨市第一医院妇科, 黑龙江哈尔滨, 150010

基金项目:

江苏省第五期“333工程”科研项目资助 BRA2017105

详细信息

通讯作者:
武明娟, E-mail: mingjuanwu@126.com

中图分类号: R737.31;R713.6
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- 文章访问数: 180
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- PDF下载量: 10
出版历程
- 收稿日期: 2022-03-08
- 网络出版日期: 2022-08-22

Influencing factors of recurrence after cytoreductive surgery in patients with ovarian cancer

1.
Department of Gynecology, the 738th Sanatorium of China Aerospace Technology Group Company, Wuxi, Jiangsu, 214000
2.
Department of Gynecology, Wuxi Maternal and Child Health Care Hospital of Jiangsu Province, Wuxi, Jiangsu, 214000
3.
Department of Gynecology, Harbin First Hospital of Heilongjiang, Harbin, Heilongjiang, 150010

摘要

摘要:
目的
分析卵巢癌(OC)患者肿瘤细胞减灭术(CRS)后复发的影响因素。
方法
回顾性收集107例OC患者的资料, 所有患者均完成CRS治疗，并随访2年。根据术后2年内肿瘤复发情况将患者分为复发组和未复发组。采用Logistic回归分析探讨导致OC患者CRS术后复发的影响因素。
结果
107例OC患者中, CRS术后68例复发，复发率为63.55%;复发组患者乳腺癌易感基因-1(BRCA-1)、聚腺苷二磷酸核糖聚合酶-1(PARP-1)表达、残瘤直径、术中淋巴结清扫、糖类抗原125(CA125)水平、人附睾分泌蛋白4(HE4)水平与未复发组比较，差异有统计学意义(P < 0.05);复发组和未复发组OC患者的年龄、肿瘤直径、国际妇产科联合会(FIGO)分期、组织分型、产次、术前绝经、淋巴结转移、不同分化程度肿瘤细胞占比、血清糖类抗原199(CA199)、癌胚抗原(CEA)比较，差异无统计学意义(P>0.05)。Logistic回归分析结果显示, BRCA-1阳性表达、PARP-1阳性表达、残瘤直径>1 cm、术中未清扫淋巴结、CA125水平升高、HE4水平升高可能是OC患者CRS术后复发的危险因素(OR>1, P < 0.05)。
结论
BRCA-1阳性表达、PARP-1阳性表达、残瘤直径>1 cm、术中未清扫淋巴结、CA125水平升高、HE4水平升高可能是OC患者CRS术后复发的危险因素。
- 卵巢癌 /
- 肿瘤细胞减灭术 /
- 糖类抗原125 /
- 乳腺癌易感基因-1 /
- 聚腺苷二磷酸核糖聚合酶-1 /
- 人附睾分泌蛋白4
Abstract:
Objective
To analyze the influencing factors of recurrence after cytoreductive surgery (CRS) in patients with ovarian cancer (OC).
Methods
Data of 107 OC patients were retrospectively collected, and all patients completed CRS treatment and were followed up for 2 years. These patients were divided into recurrence group and non-recurrence group according to tumor recurrence within 2 years after surgery. Logistic regression analysis was used to investigate the influencing factors of postoperative recurrence of CRS in OC patients.
Results
Among 107 OC patients, 68 patients relapsed after CRS, with a recurrence rate of 63.55%. The expression of breast cancer susceptibility gene-1 (BRCA-1), poly adenosine diphosphate ribose polymerase-1 (PARP-1), residual tumor diameter, intraoperative lymph node dissection, carbohydrate antigen 125 (CA125) level and human epididymal protein 4 (HE4) level showed significant differences between the recurrence group and the non-recurrence group (P < 0.05). Compared age, tumor diameter, International Federation of Gynecology and Obstetrics(FIGO) stage, disease type, histological type, delivery times, preoperative menopause, lymph node metastasis, proportion of tumor cells with different degrees of differentiation, serum CA199 and carcinoembryonic antigen (CEA) between recurrent and non-recurrent OC patients, there was no statistical significant difference (P>0.05). Logistic regression analysis showed that BRCA-1 positive expression, PARP-1 positive expression, residual tumor diameter >1 cm, unperformed intraoperative lymph node dissection, increased CA125 and HE4 levels might be the influencing factors of postoperative recurrence after CRS in OC patients (OR>1, P < 0.05).
Conclusion
BRCA-1 positive expression, PARP-1 positive expression, residual tumor diameter >1 cm, intraoperative uncleaned lymph nodes, increased CA125 and HE4 levels may be the risk factors of postoperative recurrence after CRS in OC patients.
- ovarian cancer /
- cytoreductive surgery /
- carbohydrate antigen 125 /
- breast cancer susceptibility gene-1 /
- poly adenosine diphosphate ribose polymerase-1 /
- human epididymal secretory protein 4

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图 1 OC患者CRS术后复发情况

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图 2 OC患者CRS术后各因素预测患者术后复发的ROC曲线

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表 1 复发组和未复发组OC患者相关基线资料比较(x±s)[n(%)][M(P₂₅, P₇₅)]

基线资料	分类	复发(n=68)	未复发(n=39)	t/Z/χ²/U	P
年龄/岁		56.35±2.25	56.00±2.28	0.777	0.439
肿瘤直径/cm		6.85±0.79	6.69±0.75	1.075	0.285
国际妇产科联合会分期	Ⅲ期	35(51.47)	27(69.23)	1.783	0.075
	Ⅳ期	33(48.53)	12(30.77)
组织分型	浆液性	33(48.53)	19(48.72)	0.106	0.948
	黏液性	23(33.82)	14(35.90)
	其他	12(17.65)	6(15.38)
乳腺癌易感基因-1	阳性	63(92.65)	30(76.92)	5.389	0.020
	阴性	5(7.35)	9(23.08)
聚腺苷二磷酸核糖聚合酶-1	阳性	56(82.35)	25(64.10)	4.488	0.034
	阴性	12(17.65)	14(35.90)
残瘤直径	>1 cm	32(47.06)	9(23.08)	6.031	0.014
	≤1 cm	36(52.94)	30(76.92)
产次/次		3.00(2.00, 3.00)	3.00(1.00, 3.00)	0.236	0.813
术前绝经	是	42(61.76)	21(53.85)	0.641	0.423
	否	26(38.24)	18(46.15)
淋巴结转移	有	49(72.06)	29(74.36)	0.066	0.796
	无	19(27.94)	10(25.64)
术中淋巴结清扫	有	42(61.76)	33(84.62)	6.174	0.013
	无	26(38.24)	6(15.38)
肿瘤细胞分化程度	中高分化	34(50.00)	26(66.67)	2.795	0.095
	低分化	34(50.00)	13(33.33)
糖类抗原125/(U/mL)		45.41(44.69, 49.92)	41.70(39.12, 44.02)	7.389	< 0.001
糖类抗原199/(U/mL)		44.69±5.26	43.45±4.84	1.215	0.227
人附睾分泌蛋白4/(pmol/L)		185.90(177.40, 193.17)	169.22(161.39, 175.61)	7.156	< 0.001
癌胚抗原/(ng/mL)		12.01±2.53	11.28±2.29	1.485	0.141

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表 2 影响因素赋值情况

影响因素	变量类型	赋值
国际妇产科联合会分期	分类变量	0=Ⅲ期, 1=Ⅳ期
乳腺癌易感基因-1	分类变量	0=阴性, 1=阳性
聚腺苷二磷酸核糖聚合酶-1	分类变量	0=阴性, 1=阳性
残瘤直径	分类变量	0=≤1 cm, 1=>1 cm
术中淋巴结清扫	分类变量	0=有, 1=无
肿瘤细胞分化程度	分类变量	0=中高分化, 1=低分化
糖类抗原125	连续变量	—
人附睾分泌蛋白4	连续变量	—

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表 3 OC患者CRS术后复发的危险因素分析

因素	B	S. E.	Wald	P	OR	95%CI
常量	29.823	7.294	16.718	< 0.001	—	—
乳腺癌易感基因-1	1.990	0.956	4.330	0.037	7.313	1.123~47.641
聚腺苷二磷酸核糖聚合酶-1	0.906	0.640	2.005	0.157	2.474	0.706~8.665
国际妇产科联合会分期	1.113	1.197	0.864	0.352	3.044	0.291~31.800
残瘤直径	1.343	0.621	4.678	0.031	3.831	1.134~12.938
术中淋巴结清扫	1.542	0.671	5.275	0.022	4.674	1.254~17.429
肿瘤细胞分化程度	1.076	1.090	0.975	0.323	2.933	0.347~24.812
糖类抗原125	0.332	0.090	13.680	< 0.001	1.394	1.169~1.663
人附睾分泌蛋白4	0.070	0.032	4.793	0.029	1.073	1.007~1.142

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表 4 BCRS术后各因素对OC患者CRS术后复发的预测价值

项目	AUC	cut-off值	AUC的95%CI	P	特异度	敏感度	约登指数
预测概率	0.896	0.550	0.837~0.956	< 0.001	0.821	0.809	0.630

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