术前超敏C反应蛋白对评估宫颈鳞癌预后的价值

Prognostic Value of Preoperative Serum High Sensitivity C-reactive Protein in Patients with Squamous Cervical Cancer

【目的】探讨术前血清超敏C反应蛋白(hs-CRP)水平是否可作为评价宫颈鳞癌患者预后的因素。【方法】对2005年6月至2013年10月在中山大学孙逸仙纪念医院妇科肿瘤专科进行初始治疗的989例宫颈鳞癌患者的临床病理资料进行回顾性研究,分析术前血清hs-CRP水平与临床病理参数、无瘤生存期及总生存期的相关性,同时分析hs-CRP水平与SCCA的相关性。对照组为我院同期的体检人群989例。【结果】研究组术前血清hs-CRP平均秩次高于对照组[中位数(四分位间距)分别为2.72(2.48)mg/L和1.76(4.92)mg/L,P=0.011],其与肿瘤分期、分化程度、淋巴结转移、宫颈间质浸润深度、宫旁受累以及患者年龄有关。单因素分析显示,肿瘤分期、分化程度、淋巴结转移、宫颈间质浸润深度、宫旁受累、患者年龄及治疗前hs-CRP和SCCA水平与宫颈鳞癌患者的无瘤生存期及总生存期相关;多因素分析显示仅肿瘤分期、淋巴结转移及治疗前hs-CRP水平与无瘤生存期及总生存期有关。秩和相关分析结果显示,术前血清hs-CRP与SCCA呈正相关[Spearman相关系数rs=0.206,P<0.000(双侧)]。【结论】术前血清hs-CRP水平有可能作为判断宫颈鳞癌预后的指标,但其价值需要进一步评估。

[Objective] To evaluate whether high sensitivity C-reactive protein （hs-CRP） is a predictive factor in patients with squamous cervical cancer. [Methods] We retrospectively analyzed the records of 989 patients with squamous cervical cancer treated in our institution for their initial serum hs-CRP level before therapy. Mann-Whitney U and K independent samples test were used to evaluate the association of the hs-CRP levels with variables associated with a poor prognosis. Kaplan-Meier analysis and Cox proportional hazards model were used to perform univariate and multivariate analyses. Healthy control group was 989. [Results] The median hs-CRP serum level in patients with squamous cervical cancer was higher than the control group （2.72 （2.48） mg/L vs 1.76 （4.92） mg/L,P=0.011）. Hs-CRP serum levels were significantly associated with advanced tumor stage, histological grade, lymph node involvement, the depth of cervical stromal invasion, parametrial involvement, and patients＇ age. Tumor stage, histological grade, lymph node involvement, the depth of cervical stromal invasion, parametrial involvement, patients＇ age, hs-CRP and SCCA serum levels were correlated with overall and disease-free survival; tumor stage, lymph node involvement, and hs-CRP serum level were independently prognostic factors. The rank correlation analysis showed that there was a positive correlation between serum hs- CRP and SCCA [ r, = 0.206,P 〈 0.000 （two-sides） ]. [ Conclusion ] Hs-CRP serum levels may work as a prognostic parameter in patients with cervical cancer. Further investigation is deserved to validate its value.