术前淋巴细胞与单核细胞比值联合CA125在上皮性卵巢癌预后评估中的作用

Role of preoperative lymphocyte to monocyte ratio combined with CA125 in prognosis evaluation of epithelial ovarian cancer

目的:评估术前淋巴细胞与单核细胞比值(LMR)联合血清糖链抗原125(CA125)对上皮性卵巢癌(EOC)患者预后的预测价值,分层探讨LMR-CA125作为EOC患者预后指标的价值。方法:回顾性选取2015年1月至2019年12月于盐城市第二人民医院妇科初治的EOC患者120例。术前计算LMR,绘制受试者工作特征(ROC)曲线确定LMR、CA125界值和分组,结合随访生存情况分析LMR-CA125与EOC患者临床病理因素及预后的关系。结果:(1)LMR、CA125最佳预测界值分别为3.9、37.5 U·ml^(-1)。患者分为3组:0分组(LMR≥3.9,CA125<37.5 U·ml^(-1)),1分组[(LMR≥3.9,CA125≥37.5 U·ml^(-1))或(LMR<3.9,CA125<37.5 U·ml^(-1))],2分组(LMR<3.9,CA125≥37.5 U·ml^(-1))。LMR-CA125判断患者预后的ROC曲线下面积(AUC)大于单指标LMR、CA125(Z=3.027,P=0.003;Z=2.997,P=0.003)。(2)年龄、FIGO分期、分化程度及淋巴结转移在LMR-CA125不同分组间比较,差异均有统计学意义(均P<0.05)。(3)Cox回归多因素分析显示,FIGO分期(Ⅲ-Ⅳvs.Ⅰ-Ⅱ,HR=5.680,95%CI:2.557~12.616,P<0.001)、分化程度(差vs.中-好,HR=5.265,95%CI:2.787~9.945,P<0.001)、淋巴结转移(是vs.否,HR=1.989,95%CI:1.152~3.432,P=0.014)及LMR-CA125(2分组vs.0分组,HR=5.006,95%CI:2.587~9.687,P<0.001)是影响EOC患者预后的独立危险因素。结论:LMR-CA125可作为EOC患者预后的有效预测指标,高LMR-CA125提示患者预后不良。

Objective:To investigate the prognostic value of preoperative lymphocyte to monocyte ratio(LMR)combined with serum carbohydrate antigen 125(CA125)in patients with epithelial ovarian cancer(EOC),and to explore the value of LMR-CA125 as a prognostic indicator for EOC patients.Methods:From January 2015 to December 2019,120 EOC patients in Yancheng Second People’s Hospital were enrolled in this study.LMR was calculated before operation,receiver operating characteristic(ROC)curve was drawn to determine the cut-off value and grouping of LMR and CA125.The relationship between LMR-CA125 and clinicopathological factors for prognosis of EOC patients was analyzed in combination with follow-up survival.Results:(1)The cut-off values of LMR and CA125 were 3.9 and 37.5 U·ml^(-1),respectively.Patients were divided into three groups:group 0(LMR≥3.9,CA125<37.5 U·ml^(-1)),group 1[(LMR≥3.9,CA125≥37.5 U·ml^(-1))or(LMR<3.9,CA125<37.5 U·ml^(-1))],and group 2(LMR<3.9,CA125≥37.5 U·ml^(-1))].The area under curve(AUC)of LMR-CA125 was higher than that of LMR and CA125(Z=3.027,P=0.003;Z=2.997,P=0.003).(2)There were significant differences in age,FIGO stage,degree of differentiation and lymph node metastasis among different groups of LMR-CA125(all P<0.05).(3)Multivariate Cox regression analysis showed that FIGO stage(Ⅲ-Ⅳvs.Ⅰ-Ⅱ,HR=5.680,95%CI:2.557-12.616,P<0.001),differentiation degree(poor vs.moderate-good,HR=5.265,95%CI:2.787-9.945,P<0.001),lymph node metastasis(yes vs.no,HR=1.989,95%CI:1.152-3.432,P=0.014)and LMR-CA125(group 2 vs.group 0,HR=5.006,95%CI:2.587-9.687,P<0.001)were independent risk factors for the prognosis of EOC patients.Conclusion:LMR-CA125 can be used as an effective predictor of the prognosis of EOC patients.High LMR-CA125 indicates poor prognosis.