血清YKL-40在浆液性上皮性卵巢癌诊断和病情评估中的价值

YKL-40 in the diagnosis and prediction of prognosis in serous epithelial ovarian cancer

目的评价血清YKL-40对浆液性上皮性卵巢癌诊断和病情评估的价值。方法选取2017年1月~2018年6月在我院诊治的114例附件包块需行手术治疗的患者,其中良性卵巢肿瘤46例,恶性卵巢肿瘤68例。术前1d采集空腹静脉全血5ml待测,收集患者的病理类型、临床分期、组织学分级等,比较良恶性卵巢肿瘤的YKL-40、CA125的水平,并分析其与临床分期、组织学分级及术后复发的相关性。结果卵巢浆液性上皮癌中YKL-40和CA-125水平明显高于良性卵巢肿瘤,差异有统计学意义(P<0.05)。YKL-40的截断值为46.5μg/L时,诊断的敏感性为82.2%,特异性为66.1%.ROC曲线下面积YKL-40(AUC=0.819)大于CA125(AUC=0.733)。YKL-40在临床分期Ⅲ期、组织学分化3级的患者血清中的表达水平明显高于Ⅰ期、组织学分化1级的表达水平,差异有统计学意义(P<0.05)。YKL-40术前水平越高其临床分期越高、组织学分级越低。术后复发患者的术前血YKL-40水平明显高于无复发患者。结论YKL-40在浆液性上皮性卵巢癌中明显升高,有较高的敏感性和特异性,并且与患者的临床分期和组织学分化以及术后复发等相关,可作为一种新的鉴别卵巢良恶性肿瘤的标志物。

Objective To evaluate the use of YKL-40 in the discrimination between benign and malignant adnexal mass and to determine its prognostic value in assessing residual tumor after primary cytoreduction in serous epithelial ovarian carcinoma(EOC).Methods During the four yearsfrom January 2016 to Januaryl 2020,a nonconsecutive series of 114100 patient(68 malignant,46 benign)who underwent surgery for an adnexal mass were enrolled in the study.Blood samples were collected preoperatively from these patients who were planned to undergo surgery for an adnexal mass in our clinic.The levels of YKL-40 in the discrimination between benign and EOC were compared.we analyzed the relationship between preoperative serum YKL-40 and clinicopathologic features of patients with serous EOC,such as stage,grade,and recurrence.Results Serum YKL-40 and CA-125 levels were significantly higher in patients with serous EOC(P<0.05).Sensitivity was 82.2%and specificity was 66.1%,respectively,when a cut-off serum YKL-40 level of 46.5μg/L was applied.The obtained areas under the ROC curves for YKL-40(AUC=0.819)were greater than for CA125(AUC=0.733).Serum YKL-40 levels of patients with stage III and histological differentiation grade 3 was higher than that of patients with stage I and histological differentiation grade 1(P<0.05).Significantly increased serum levels of YKL-40 were observed in patients with advanced stage and higher grade disease.The comparison of preoperative serum YKL-40 levels between patients with and without recurrence demonstrated signicificantly elevated levels in the latter patients.Conclusion The level of YKL-40 is significantly elevated in serous epithelial ovarian cancer and has high sensitivity and specificity.It is also associated with clinical stage,histological differentiation and postoperative recurrence.Therefore,YKL-40 can be used as a new marker for the differentiation of benign and malignant ovarian tumors.