血清CA153,CA125水平与老年Luminal型乳腺癌患者内分泌治疗耐药的关系

Relationship between serum CA153,CA125 levels and drug resistance to endocrine therapy in elderly patients with Luminal breast cancer

目的探究老年Luminal型乳腺癌患者血清糖类抗原153(CA153)、糖类抗原125(CA125)水平与内分泌治疗耐药的相关性。方法选取158例2018年6月至2022年6月于甘肃省肿瘤医院接受乳腺癌内分泌治疗后复查的60岁以上已绝经的Luminal型乳腺癌患者,根据是否出现耐药,分为耐药组(n=104)和敏感组(n=54)。对比两组患者的一般资料,Spearman相关性分析血清CA153、CA125水平与临床病理特征的关系,限制性立方样条模型(RCS)分析血清CA153和CA125水平与内分泌耐药的剂量-反应关系,Logisitic回归分析内分泌治疗耐药的危险因素。以危险因素建立临床预测模型,其中模型一不包含CA153,模型二包含全部因素,对两个预测模型进行ROC分析和Hosmer-Lemeshow检验。结果158例患者内分泌治疗耐药率为65.83%,两组患者的年龄、肿瘤直径、淋巴结转移、T分期、N分期、组织学分级、血清CA153水平、血清CA125水平的差异均具有统计学意义(P<0.05)。血清CA153,CA125水平与年龄、肿瘤直径、淋巴结转移、T分期、N分期均呈正相关,血清CA153,CA125水平与组织学分级呈负相关。调整混杂因素后,血清CA153水平>171.28 U/mL、CA125水平>186.32 U/mL与内分泌治疗耐药具有强相关性。Logistic回归分析结果显示,高龄、肿瘤较大、T分期较高、N分期较高、组织学分级G3、血清CA153水较高、血清CA125水较高均是内分泌治疗耐药的独立危险因素(P<0.05)。模型一的ROC曲线下面积为0.823(95%CI:0.702~0.862),模型二的ROC曲线下面积为0.884(95%CI:0.783~0.891)。Hosmer-Lemeshow检验显示预测模型一P=0.763,预测模型二P=0.975,均提示拟合优度良好。结论血清CA153,CA125水平具有对内分泌治疗耐药的预测价值,血清CA153,CA125水平越高则内分泌治疗耐药风险越高。

Objective Explore the relationship between serum levels of carbohydrate antigen 153(CA153),carbohydrate antigen 125(CA125)and drug resistance to endocrine therapy in elderly patients with Luminal breast cancer.Methods A total of 158 post-menopausal Luminal breast cancer patients over 60 years old who received endocrine therapy for breast cancer in Gansu Provincial Cancer Hospital from June 2018 to June 2022 were selected and divided into a drug-resistant group(n=104)and a sensitive group(n=54)according to whether drug resistence occurred.The general data of the two groups were compared.Spearman correlation analysis was used to analyze the relationship between serum CA153,CA125 level and clinicopathological features.Restricted cubic splines(RCS)model was used to analyze the dose-response relationship between serum CA153 and CA125 levels and endocrine drug resistance.Logisitic regression was used to analyze the risk factors of drug resistance in endocrine therapy.A clinical predictive model was established based on risk factors.Model one does not contain CA153,while model two contains all factors.ROC analysis and Hosmer-Lemeshow test were carried out on the two prediction models.Results The drug resistance rate of endocrine therapy was 65.83%.There were significant differences in age,tumor diameter,lymph node metastasis,T stage,N stage,histological grading,serum CA153 level and serum CA125 level between the two groups(P<0.05).Serum CA153,CA125 levels were positively correlated with age,tumour diameter,lymph node metastasis,T-stage and N-stage,and serum CA153,CA125 levels were negatively correlated with histological grading.After adjusting for confounders,serum CA153 levels greater than 171.28 U/mL and CA125 levels greater than 186.32 U/mL were strongly correlated with endocrine therapy resistance.Logistic regression analysis showed that advanced age,larger tumor,higher T stage,higher N stage,histological classification G3,higher serum CA153 water and higher serum CA125 water were independent risk factors for drug resistance to endocrine therapy(P<0.05).The area under the ROC curve of model 1 is 0.823(95%CI:0.702-0.862).The area under the ROC curve of model 2 is 0.884(95%CI:0.783-0.891).Hosmer-Lemeshow test showed that the prediction model one was 0.763 and the prediction model two was P=0.975.All of them suggested that the goodness of fit was good.Conclusions he level of serum CA153,CA125 can predict the drug resistance of endocrine therapy.The higher the serum CA153,CA125 level,the higher the risk of drug resistance to endocrine therapy.