人附睾蛋白4在卵巢癌诊断及预后评估中价值

Value of human epididymal protein 4 to the diagnosis and prognosis assessment of ovarian cancer

目的观察卵巢癌患者尿液及血清人附睾蛋白4(human epididymis protein 4,HE4)水平,探讨其在临床诊断及预后评估中的价值。方法卵巢癌患者33例为卵巢癌组,其中FIGO分期Ⅰ期10例,Ⅱ期5例,Ⅲ期11例,Ⅳ期7例,均行全面分期术/减瘤术;卵巢良性疾病患者33例为卵巢良性病变组,同期体检健康者33例为对照组。3组均检测尿液及血清HE4水平,比较3组及不同FIGO分期卵巢癌患者尿液及血清HE4水平。随访观察卵巢癌患者生存情况,采用多因素Cox比例风险回归模型分析卵巢癌患者术后疾病进展及发生全因死亡的危险因素。结果卵巢癌组尿液、血清HE4水平[(11.84±4.52)、(150.67±21.47)pmol/L]均高于卵巢良性病变组[(3.31±1.35)、(45.52±12.62)pmol/L]和对照组[(3.26±1.15)、(35.31±9.41)pmol/L](P<0.05);FIGO分期Ⅲ、Ⅳ期患者尿液HE4[(19.67±5.21)、(21.34±5.23)pmol/L]及血清HE4[(170.23±25.28)、(180.74±26.34)pmol/L]水平均高于Ⅰ期[(10.52±3.21)、(107.33±17.83)pmol/L]、Ⅱ期患者[(12.27±3.26)、(118.15±20.21)pmol/L](P<0.05),Ⅰ期与Ⅱ期、Ⅲ与Ⅳ期患者尿液及血清HE4水平比较差异均无统计学意义(P>0.05)。随访36个月,33例卵巢癌患者中病情进展死亡24例,总生存期为(10.2±2.1)个月。FIGO分期Ⅲ/Ⅳ期及尿液HE4≥6.32 pmol/L是卵巢癌患者术后疾病进展和死亡的危险因素(HR=3.50,95%CI:1.720~6.275,P=0.024;HR=5.65,95%CI:1.840~13.260,P=0.013)。结论卵巢癌患者尿液及血清HE4水平均明显升高,FIGO高分期和尿液高HE4水平是卵巢癌患者术后疾病进展和死亡的危险因素。

Objective To observe the levels of urine and serum human epididymal protein 4(HE4)and to investigate their values to the diagnosis and prognosis assessment of ovarian cancer.Methods Thirty-three patients with ovarian cancer(ovarian cancer group)were performed comprehensive staging surgery or debulking surgery,including 10 patients in FIGO stageⅠ,5 in stageⅡ,11 in stageⅢand 7 in stageⅣ,another 33 patients with benign ovarian diseases were selected as benign ovarian diseases group,and 33 healthy volunteers were as controls(control group).The urine and serum HE4 levels were detected and compared in three groups and among patients in different FIGO stages.The survival time was observed in ovarian cancer group.Multivariate Cox’s proportional hazards regression model was used to analyze the risk factors of disease progression and all-cause death after operation in ovarian cancer patients.Results The levels of urine and serum HE4 were higher in ovarian cancer group((11.84±4.52),(150.67±21.47)pmol/L)than those in benign ovarian diseases group((3.31±1.35),(45.52±12.62)pmol/L)and control group((3.26±1.15),(35.31±9.41)pmol/L)(P<0.05),were higher in patients in FIGO stageⅢ((19.67±5.21),(170.23±25.28)pmol/L)and stageⅣ((21.34±5.23),(180.74±26.34)pmol/L)than those in patients in stageⅠ((10.52±3.21),(107.33±17.83)pmol/L)and stageⅡ((12.27±3.26),(118.15±20.21)pmol/L)(P<0.05),and showed no significant differences between patients in stageⅠand stageⅡas well as between patients in stageⅢand stageⅣ(P>0.05).The 36-month follow-up showed that 24 of 33 patients died of disease progression.The overall survival time was(10.2±2.1)months.FIGO stageⅢ/Ⅳand urine HE4≥6.32 pmol/L were the risk factors of disease progression and death in patients with ovarian cancer(HR=3.50,95%CI:1.720-6.275,P=0.024;HR=5.65,95%CI:1.840-13.260,P=0.013).Conclusion The levels of urine and serum HE4 increase obviously in patients with ovarian cancer.High FIGO stage and high level of urine HE4 are the risk factors of disease progression and death.