血清CA125、HE4和影像学检查在上皮性卵巢癌术后复发诊断中的应用价值

The value of serum CA125, HE4 and imaging examinations in detecting the recurrence of postoperative ovarian cancer

背景与目的:人附睾蛋白4(human epididymis protein 4,HE4)是一种新型上皮性卵巢癌(epithelial ovarian cancer,EOC)的血清免疫标志物。本研究旨在评价其与卵巢最常用的血清标志物—糖类抗原125(cancer antigen-125,CA125)和腹、盆腔CT/MRI检查对卵巢癌术后复发的诊断价值。方法:回顾性分析EOC术后复发患者92例,其中二次手术48例,化疗44例。统计治疗前血清CA125、HE4和腹、盆腔CT/MRI检查诊断的灵敏度,并与手术病理和临床随访结果进行对照。结果:血清CA125和HE4的灵敏度分别为58.7%和61.9%。两者差异无统计学意义(P>0.05);联合两者的灵敏度为80.4%,较单一应用显著提高(P<0.05)。腹、盆腔CT/MRI的灵敏度为88.0%,显著高于血清CA125和HE4(P<0.01)。与两者联用相比,差异无统计学意义(P>0.05)。三者联合应用的灵敏度最高(97.8%),显著高于血清CA125和HE4联用(P<0.01),以及单用腹、盆腔CT/MRI(P<0.05)。结论:血清HE4对于EOC术后复发的检出与CA125同样有效,两者联合应用可显著提高诊断的灵敏度。与腹、盆腔影像学检查三者联用的灵敏度最高,是EOC术后监测较佳的策略。

Background and purpose： Human epididymis protein 4（HE4） has been suggested to be a novel biomarker of epithelial ovarian cancer（EOC）. The present study aimed to evaluate and compare HE4 with the commonly used marker, carbohydrate antigen 125（CA125） and imaging examinations in detecting the recurrence of postoperative EOC. Methods： In this study, 92 patients with the recurrence of postoperative EOC were analyzed retrospectively. The treatments method included the secondary operation（48 patients） and chemotherapy（44 patients）. The sensitivity of CA125, HE4 and CT/MRI examinations in detecting the recurrence of postoperative EOC were analyzed and correlated with surgical pathology and clinical follow-up results. Results： The sensitivity of CA125 and HE4 were 58.7% and 61.9% with no signifi cant difference（P〉0.05）. The diagnostic sensitivity of CA125 combined with HE4（80.4%） was statistically higher than that of 2 tumor marks being applied independently（P〉0.05）. The diagnostic sensitivity of CT/MRI examinations（88.0%） was statistically higher than that of CA125 and HE4（P〈0.05）, and no signifi cant difference was observed between CT/MRI and combined CA125 and HE4（P〉0.05）. The highest diagnostic sensitivity（97.8%） was attained by combining of CA125, HE4 and CT/MRI examinations, which was statistically higher than that of CA125 combined with HE4（P〈0.01）, and CT/MRI examinations（P〈0.05）. Conclusion： Serum HE4 is an effective tumor marker in detecting the recurrence of postoperative EOC as well as serum CA125. HE4 and CA125 may improve the diagnostic sensitivity statistically. The highest diagnostic sensitivity was attained by combining of CA125, HE4 and CT/MRI examinations, which is the suitable strategy in screening the patient of postoperative EOC.