围手术期CA125水平对高级别浆液性卵巢癌的预后价值研究

A study regarding prognostic value of perioperative CA125 levels in high-grade serous ovarian cancer

目的:探索围手术期癌胚抗原125(CA125)变化对高级别浆液性卵巢癌(HGSC)的预后价值。方法:回顾性研究海南省人民医院2005年1月至2015年1月诊断为HGSC并接受手术治疗的患者,收集患者临床数据及就诊时和手术后CA125数据。采用R软件的Maxstat函数包确定区分CA125水平分级的最佳界值,并进行Cox回归分析。结果:共纳入243例HGSC患者,基线CA125最佳界值为165.3 U·ml^-1,术前/术后CA125值大于6.3为预后良好指标。基线CA125水平降低和术前/术后CA125值增加与患者高总生存率有关(风险比分别为:HR=0.42,95%CI 0.25~0.70,P<0.001;HR=0.46, 95%CI 0.29~0.75,P<0.001)。结论:围手术期CA125水平对HGSC具有重要预后价值,就诊时低于165.3 U·ml^-1或术前/术后CA125值大于6.3提示更好的预后。

Objective: To explore the prognostic value of perioperative CA125 changes in high-grade serous ovarian cancer(HGSC) patients. Methods: A retrospective study was performed on patients diagnosed as HGSC undergoing surgery from January 2005 to January 2015. The clinical data, CA125 data at diagnosis and following surgery were collected. The Maxstat function package of the R software was used to determine the optimum CA125 level cutoff value. Cox regression analysis was performed to evaluate mortality based on the CA125 level. Results: A total of 243 HGSC patients were enrolled. The optimum CA125 level cutoff value was 165.3 U·ml^-1. Pre-operative/postoperative ratio higher than 6.3 was a good indicator of prognosis. The decrease of CA125 level at diagnosis and the pre-operative/post-operative CA125 ratio were associated with improved overall survival(Hazard ratios: HR=0.42, 95% CI 0.25-0.70, P<0.001;HR=0.46, 95% CI 0.29-0.75, P<0.001, respectively). Conclusion: Per-operative CA125 levels have an important prognostic value for HGSC, with a low pre-operative CA125 value or high pre-operative/post-operative CA125 ratio greater than 6.3 suggesting a better prognosis.