CT联合血清CA125水平评估卵巢癌行初次理想肿瘤细胞减灭术的临床价值

Clinical Value of Preoperative Computed Tomography Scan and Serum CA-125 Level in the Prediction of Ovarian Cancer Patients Underwent Ideal Primary Cytoreductive Surgery

目的:探讨螺旋CT扫描联合血清糖类抗原125(CA125)水平对于预测晚期卵巢癌(Ⅲ期和Ⅳ期)患者行初次理想肿瘤细胞减灭术的临床价值。方法:基于Suidan等在2014年确定的3项临床标准(年龄≥60岁、CA125≥500 U/mL、ASA3-4)及6项影像学表现(肾上腺腹膜后淋巴结>1 cm、小肠粘连及增厚、肠系膜病灶>1 cm、肝周病变>1 cm、病变侵袭肠系膜上动脉根部脉>1 cm、胃网膜病变>1 cm),收集我院收治的晚期卵巢癌患者98例进行回顾性分析,术前2周内行全腹及盆腔增强CT扫描并采集空腹血,对增强CT图像及血清CA125水平进行检测和分析,运用x^2检验及ROC曲线评价其用于预测晚期卵巢癌患者行理想肿瘤细胞减灭术的可能性。结果:98例晚期卵巢癌中,非理想肿瘤细胞减灭术患者51例,占52%。行初次理想肿瘤细胞减灭术和初次非理想肿瘤细胞减灭术卵巢癌患者3项临床标准和6项影像学表现的分布比较差异均具有统计学意义(P<0.05)。仅通过影像学评分,预测初次理想肿瘤细胞减灭术的ROC曲线下面积为0.633,而3项临床标准联合6项影像学表现时,预测初次理想肿瘤细胞减灭术ROC曲线面积为0.702。结论:基于此评分系统的建立,预测分数越高,非理想肿瘤细胞减灭术发生率越高。CT联合血清CA125水平对于评估晚期卵巢癌患者行初次理想肿瘤细胞减灭术具有一定的临床价值。

Objective： Clinical value of preoperative computed tomography scan and serum CA-125 level in the prediction of stage Ⅲ-Ⅳ ovarian cancer patients underwent ideal primary cytoreductive surgery. Methods： According to Suidan, research in 2014, they identified three clinical（：age ≥60 years, CA-125 ≥500 U/mL, ASA 3-4） and six radiologic criteria（suprarenal retroperitoneal lymph nodes 1 cm, diffuse small bowel adhesions/thickening, lesions 1 cm in the small bowel mesenter,root of the superior mesenteric artery,perisplenic area, lesser sac 1 cm）. We collected 98 patients. A CT scan of the abdomen/pelvis and serum CA125 were obtained within14 days before surgery, respectively. The correlation between CT, CA125 and surgical was analyzed by Chi-square test and Receiver operating characteristic（ROC）cult. Results： 98 patients met eligibility criteria.The optimal debulking was 51 patients and the positive rate was 54%. Three clinical and six radiologic criteria who undergo ＇optimal＇ vs ＇suboptimal＇ debulking was considered statistical significant（a p value of 0.05）. ROC curves were generated, with this six CT criteria showing an area under the curve（AUC） of 0.633. The six CT criteria, CA-125, age, and ASA, demonstrating an AUC of 0.702. Conclusions： The higher of the predicted score, the higher the incidence of optimal debulking surgery. These results may be helpful in pretreatment patient assessment.