术前血清肌酐水平对早期子宫颈腺癌患者不良预后的影响及预测价值

Preoperative serum creatinine as an independent prognostic biomarker in patients with early-stage cervical adenocarcinoma

目的探讨术前血清肌酐(Scr)水平对早期子宫颈腺癌(ADC)患者不良预后的影响及预测价值。方法收集2005—2015年在浙江大学医学院附属妇产科医院行手术治疗的199例早期ADC患者的临床病理资料,对其进行门诊和电话随访,随访时间[M(Q1,Q3)]为77.5(57.0,114.0)个月,失访11例(5.5%),复发19例(10.1%),死亡17例(9.0%)。采用多因素Cox比例风险回归模型分析早期ADC患者预后的相关因素,绘制受试者工作特征(ROC)曲线,选取约登指数最大值时所对应的数值为截断(cut-off)值,同时计算ROC曲线下面积(AUC)评价相关因素对不良预后的预测价值。结果 199例患者年龄[M(Q1,Q3)]为44.0(39.0,50.0)岁;国际妇产科联盟(FIGO)分期ⅠA1期16例(8.0%),ⅠA2期4例(2.0%),ⅠB1期147例(74.0%),ⅠB2期13例(6.5%),ⅡA1期19例(9.5%)。多因素分析显示,FIGO分期、Scr升高与早期ADC患者术后是否无瘤生存相关,HR值(95%CI)分别为4.570(1.625~12.854)、1.065(1.006~1.128)(均P<0.05);亦与术后是否死亡相关,HR值(95%CI)分别为4.412(1.458~13.350)、1.076(1.012~1.144)(均P<0.05)。Scr的最佳临界值为75.2 μmoI/L;以Scr为指标绘制ROC曲线,无瘤生存率AUC=0.677(95%CI:0.608~0.742,P=0.006),总生存率AUC=0.677(95%CI:0.607~0.741,P=0.012)。结论术前Scr水平是早期ADC患者的无瘤生存或死亡的相关因素;对于术前Scr>75.2 μmoI/L的早期ADC患者,提示预后较差。

Objective To investigate the effect of preoperative serum creatinine(Scr)level on the prognosis of patients with early cervical adenocarcinoma(ADC)and its predictive value.Methods A retrospective review was performed on 199 patients with the International Federation of Gynecology and Obstetrics(FIGO)stageⅠA1-ⅡA1 and pathology-proven invasive ADC from January 2005 to December 2015.Patients were followed up by phone and outpatient,with a median follow-up time 77.5(57.0,114.0)months,11 cases(5.5%)were missing,19 cases(10.1%)recurred,and 17 cases(9.0%)died.Multivariate analysis was performed by Cox regression model to analyze the related factors of the prognosis of ADC patients.The optimal cut-off point was determined by the analysis of receiver operating characteristics(ROC),and the predictive value of related factors for prognosis was evaluated by the area under the curve(AUC).Results The median age of 199 patients was 44.0(39.0-50.0)years.Overall,16 patients(8.0%)were stageⅠA1;4 patients(2.0%)were stageⅠA2;147 patients(74.0%)were stageⅠB1;13 patients(6.5%)were stageⅠB2;19 patients(9.5%)were stageⅡA1.The multivariate analysis showed that FIGO stage[4.570(1.625-12.854)]and elevated Scr[1.065(1.006-1.128)]were correlated with DFS in patients with early ADC,as well as correlated with OS[4.412(1.458-13.350)and 1.076(1.012-1.144),respectively(all P<0.05)].The optimal cut-off point of Scr level was 75.2μmoI/L.The AUC showed that the Scr level was a predictor of DFS(AUC=0.677,95%CI:0.608-0.742,P=0.006)and OS(AUC=0.677,95%CI:0.607-0.741,P=0.012).Conclusions The preoperative Scr level independently predicts the prognosis of early-stage ADC;patients with Scr levels>75.2μmoL/L might require more follow-up and adjuvant treatment,as they might have a poorer prognosis.