血清人附睾蛋白4在卵巢癌临床转归中的关系

The significance of serum human epididymis protein 4 of the clinical outcome of ovarian cancer

目的围手术期及化疗期间人附睾蛋白4（HE4）血清水平的变化,与卵巢癌的疗效和无瘤进展生存时间（PFS）的关系尚不清楚,本文通过检测卵巢上皮性癌不同时期的HE4水平,探讨其与卵巢癌临床转归的关系。方法 取2005年11月至2009年12月间北京大学人民医院诊治并随访完整的卵巢上皮性癌患者（n=100）的血清样本,采用酶联免疫吸附试验法,测定患者不同时期的血清HE4水平。中位随访时间为17个月（3~55个月）。结果本研究共检测了100例患者共559份血清的HE4水平。在有连续性资料的73例患者中,初治疗效为完全缓解组与未完全缓解组相比,化疗期间HE4下降更迅速,差异有统计学意义。单因素分析主要显示了首次化疗前HE4水平与PFS明显相关：首次化疗前HE4水平≤150 pmol/L组的中位PFS较HE4〉150pmol/L组延长（34 vs 17.5个月,P=0.001）。多因素分析显示,首次化疗前HE4水平未降至正常是晚期卵巢癌患者PFS的独立危险因素。首次化疗前HE4水平与残余瘤灶大小呈中度相关（r=0.458,P〈0.001）。结论手术前后及化疗期间HE4变化情况有助于判断初治效果;首次化疗前HE4水平一定程度上反映了手术的满意程度,是晚期卵巢癌的PFS的相对独立影响因素。

Objective The relationship between the variation of serum Human Epididymis Protein 4（HE4） during the perioperation period and chemotherapy and the efficacy and progress-free survival（PFS） of ovarian cancer was still unclear.The purpose of this test was to explore their relationship by detecting HE4 at different courses of epithelial ovarian cancer.Methods The data of 100 epithelial ovarian cancer patients who were diagnosed and treated in Peking University People＇s Hospital（from Nov 2005 to Dec 2009,complete follow-up data） were analyzed retrospectively.The median follow-up period was 17 months（ranged from 3 to 33 months）.The HE4 level was assayed through ELISA.Results 559 serum samples of HE4 were assayed.Of the 73 cases with serial data,HE4 level in complete-remission group declined more quickly during chemotherapy than incomplete-remission group（P0.05）.By Kaplan-Meier survival analysis,HE4 150 pmol/L before the first chemotherapy was a risk factor for PFS.The median PFS was longer in HE4≤150 pmol/L group than in HE4150 pmol/L group（34 mon vs 17.5 mon,P=0.001）.By multivariate Cox analysis,it was an independent risk factor for PFS in those advanced ovarian cancer whose HE4 level before the first chemotherapy didn＇t decline to normal range.Additionally,HE4 before the first chemotherapy was moderately related to the size of residual tumor masses（r=0.458,P0.001）.Conclusions The variation of HE4 during therapy may be helpful to assess the curative effect of primary treatment.HE4 level before the first course of chemotherapy reflected the radicality of operation partly,and was an independent influencing factor for PFS in advanced ovarian cancer.