血清肿瘤标志物对Ⅰ～Ⅱ期宫颈小细胞癌预后的预测价值

Prognostic value of serum tumor markers for FIGO stage Ⅰ-Ⅱ small cell carcinoma of the cervix

目的 探讨宫颈小细胞癌（SCCC）治疗前血清肿瘤标志物表达在宫颈小细胞癌预后中的预测价值。方法 回顾性分析2004年4月~2014年4月在浙江省肿瘤医院接受治疗的50例Ⅰ~Ⅱ期SCCC患者的临床资料,分析患者治疗前血清肿瘤标志物CA125、CA199、CEA、SCC的表达水平与患者预后的关系。采用Kaplan-Meier法进行单因素生存分析,以Log-rank test确定统计学上的显著差异,采用Cox比例风险模型进行多因素生存分析。结果 所有患者治疗前均接受血清肿瘤标志物的检测并均接受手术及化疗。随访截至2014年9月10日,全组患者中位无进展生存时间36.4个月,1、3年及5年无进展生存率分别为64.8%、47.9%和47.9%。血清肿瘤标志物CA125、CA199、CEA、SCC阳性患者的平均无进展生存期及3、5年生存率较CA125、CA199、CEA、SCC阴性患者低。单因素分析发现治疗前血清肿瘤标志物CA125、CA199、CEA、SCC阳性及阴性患者的生存率差异无统计学意义（P〉0.05）。联合盆腔放疗及术后病理高危因素（深间质受侵、脉管瘤栓、盆腔淋巴结阳性）均可影响患者无进展生存期（P〈0.05）,脉管瘤栓是影响患者预后的独立因素（OR=4.564,P=0.033）。结论 目前尚不能明确治疗前血清肿瘤标志物CA125、CA199、CEA、SCC表达水平可以预测Ⅰ~Ⅱ期SCCC患者预后。血清肿瘤标志物对SCCC患者预后的影响值得临床进一步研究。

Objective To investigate the prognostic value of serum tumor markers before treatment for FIGO stage Ⅰ - Ⅱ small cell carcinoma of the cervix. Methods Clinical data of 50 patients with small cell carcinoma of the cervix （SC- CC） from April 2004 to April 2014 treated in Zhejiang Cancer Hospital were analyzed retrospectively. The relationships between the expression of serum tumor markers CA125, CA199, CEA, SCC before treatment and the prognosis of pa- tients were analyzed. Single factor analysis was performed by using the Kaplan-Meier method. The statistical signifi- cance was determined by the Log-rank test. Multi-factor survival analysis was performed by using Cox proportional hazards models. Results The serum tumor markers of patients were detected before treatment, then underwent surgery and chemotherapy. Followed-up to September 10, 2014, median progression-free survival time of all patients was 36.4 months, 1, 3 years and 5 years progression-free survival rates were 64.8%, 47.9% and 47.9% respectively. Compared with the patients with negative expression of serum tumor markers CA125, CA199, CEA and SCC, the average progres- sion-free survival and 3, 5 years progression-free survival rate of the patients with positive expression of serum CA125, CA199, CEA, and SCC were lower. Single factor analysis showed that the difference of progression-free survival be- tween patients with serum tumor markers CA125, CA199 and CEA, SCC positive or negative before the treatment was no statistically significant difference （P 〉 0.05）. Patients progression-free survival time could be affected by combina-tion pelvic radiation therapy and postoperative patho- logical risk factors （depth stromal invasion, lymphovas- cular space invasion, pelvic lymph node involvement） （P 〈 0.05）. In a muhivariable analysis, lymphovascular space invasion for FIGO stage I - lI SCCC remainedas independent prognostic factor of survival （OR = 4.564,P = 0.033）. Conclusion Currently, it is not clear that the serum tumor markers CA125, CA199, CEA, SCC expression level before treatment can predict the prognosis of patients with FIGO stage Ⅰ - Ⅱ SCCC,it is worthy of further study in the clinical practice.