外周血MLR联合ROMA指数对卵巢癌的诊断及预后评估的临床意义

Clinical significance of peripheral blood MLR combined with ROMA index in the diagnosis and prognosis evaluation of ovarian cancer

目的探讨外周血单核细胞计数与淋巴细胞计数比值(monocyte-to-lymphocyte ratio,MLR)联合卵巢癌风险评估模型(risk of ovarian malignancy algorithm,ROMA)指数对卵巢癌的诊断及预后评估的临床意义。方法选择2018年1月~2020年2月本院收治的131例行卵巢切除术患者为研究对象,其中42例良性卵巢疾病患者为对照组,89例卵巢癌患者为研究组。术前检测所有患者外周血MLR,并计算ROMA指数,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线),以曲线下面积(area under the curve,AUC)分析外周血MLR、ROMA指数及二者联合对卵巢癌的诊断价值。随访2年,根据卵巢癌患者的预后情况将其分为复发组与未复发组,比较复发组与未复发组的临床资料及术前外周血MLR、ROMA指数,Logistic多因素回归分析卵巢癌患者术后2年内复发的影响因素,以AUC分析外周血MLR、ROMA指数及二者联合对卵巢癌患者术后2年内复发的预测价值。结果研究组外周血MLR、ROMA指数均高于对照组(P<0.05);外周血MLR、ROMA指数及二者联合诊断卵巢癌的AUC值(95%CI)分别为0.658(0.570~0.738)、0.675(0.588~0.754)、0.720(0.635~0.795);随访2年,89例卵巢癌术后患者复发15例,复发率为16.85%,剩余74例均未复发;复发组肿瘤直径≥5 cm、组织学分化程度为低分化例数占比、术前血管内皮生长因子(vascular endothelial growth factor,VEGF)、外周血MLR、ROMA指数均高于未复发组(P<0.05);Logistic多因素回归分析结果显示,组织学分化程度为低分化、术前外周血MLR、ROMA指数均为卵巢癌患者术后2年内复发的影响因素(P<0.05)。外周血MLR、ROMA指数及二者联合预测卵巢癌患者术后2年内复发的AUC值(95%)分别为0.693(0.586~0.786)、0.741(0.637~0.828)、0.751(0.648~0.837)(P<0.05)。结论外周血MLR、ROMA指数可用于诊断与评估卵巢癌预后,且二者联合具有更高的诊断价值与预测价值。

Objective To investigate the clinical significance of peripheral blood monocyte-to-lymphocyte ratio(MLR)combined with risk of ovarian malignancy algorithm(ROMA)index in the diagnosis and prognosis evaluation of ovarian cancer.Methods A total of 131 patients with oophorectomy who were admitted to our hospital from January 2018 to February 2020 were selected as the research objects,of which 42 patients with benign ovarian disease were as the control group,and 89 patients with ovarian cancer were as the research group.Peripheral blood MLR was detected in all patients before surgery,and ROMA index was calculated.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was used to analyze the diagnostic value of peripheral blood MLR,ROMA index and their combination for ovarian cancer.Followed up for 2 years,according to the prognosis of ovarian cancer patients,they were divided into recurrence group and non-recurrence group.The clinical data and preoperative peripheral blood MLR and ROMA indexes of the recurrence group and the non-recurrence group were compared.Logistic multivariate regression analysis was used to analyze the influencing factors of recurrence in patients with ovarian cancer within 2 years after operation,and the predictive value of peripheral blood MLR,ROMA index and the combination of the two in patients with ovarian cancer within 2 years after operation was analyzed by AUC.Results The MLR and ROMA indexes of peripheral blood in the research group were higher than those in the control group(P<0.05).The AUC values(95%CI)of peripheral blood MLR,ROMA index and their combination diagnosis of ovarian cancer were 0.658(0.570~0.738),0.675(0.588~0.754),0.720(0.635~0.795),respectively.Followed up for 2 years,15 of 89 patients with ovarian cancer had recurrence after surgery,the recurrence rate was 16.85%,and the remaining 74 patients had no recurrence.The recurrence group had higher tumor diameter≥5 cm,the proportion of poorly differentiated histological differentiation,preoperative vascular endothelial growth factor(VEGF),peripheral blood MLR and ROMA index than those in the non-recurrence group(P<0.05).Logistic multivariate regression analysis showed that the degree of histological differentiation was poorly differentiated,preoperative peripheral blood MLR,and ROMA index were the influencing factors for ovarian cancer recurrence within 2 years after surgery(P<0.05).The AUC values(95%)of peripheral blood MLR,ROMA index and their combination to predict the recurrence of ovarian cancer within 2 years after surgery were 0.693(0.586~0.786),0.741(0.637~0.828),0.751(0.648~0.837),respectively(P<0.05).Conclusion Peripheral blood MLR and ROMA index can be used for the diagnosis and prognostic evaluation of ovarian cancer,and the combination of the two has higher diagnostic value and predictive value.