子宫内膜样腺癌卵巢转移的影响因素及其预测模型

Influencing factors of ovarian metastasis in patients with endometrioid adenocarcinoma and its predictive model

目的探讨子宫内膜样腺癌卵巢转移的影响因素及其预测模型。方法182例子宫内膜样腺癌患者根据有无卵巢转移分为转移组(n=13)和无转移组(n=169),收集2组患者的一般临床资料[年龄、体质量指数(BMI)、绝经情况]和疾病相关因素信息(肿瘤部位、宫颈受累情况、肿瘤最大径、淋巴转移情况、腹水细胞学检查结果);抽取2组患者术前空腹静脉血,采用罗氏Cobas e601全自动免疫分析仪检测血清D-二聚体、纤维蛋白原、糖类抗原125(CA125)、中性粒细胞/淋巴细胞比值(NLR)、人附睾分泌蛋白4(HE4)、血管内皮生长因子(VEGF)、可溶性血管内皮生长因子受体-1(sFLT1)、淋巴细胞—分化簇105(CD105)、糖链抗原19-9(CA19-9)、细胞角蛋白19片段(CK19)水平;采用多因素logistic法分析各因素的综合作用并构建列线图预测模型,再采用ROC曲线及计算机模拟充分采样(bootstrap)法对模型进行验证。结果182例子宫内膜样腺癌患者中有13例(7.14%)出现卵巢转移;经调整混杂因素的多因素分析结果显示,宫颈受累情况、淋巴转移情况、腹水细胞学检查阳性、D-二聚体水平升高、CA125水平升高、HE4水平升高、CK19水平升高是子宫内膜样腺癌患者发生卵巢转移的影响因素(P<0.05);据多因素分析结果建立列线图预测模型,ROC分析评估结果显示曲线下面积(AUC)为0.899、95%CI为0.843~0.955,bootstrap法内部验证结果显示平均绝对误差为0.024,预测模型与理想模型拟合度较高。结论子宫内膜样腺癌卵巢转移的影响因素有宫颈受累情况、淋巴转移情况、腹水细胞学检查阳性、D-二聚体水平升高、CA125水平升高、HE4水平升高及CK19水平升高,据此构建的列线图模型具有较高的准确度与区分度,可用于子宫内膜样腺癌卵巢转移的风险预测。

Objective To investigate the influencing factors and predictive models of ovarian metastasis in patients with endometrioid adenocarcinoma.Methods A total of 182 patients with endometrial adenocarcinoma were divided into metastasis group(n=13)and non-metastasis group(n=169)according to the presence or absence of ovarian metastasis.The general clinical data(age,BMI index,menopause status),disease-related factors(tumor site,cervical involvement,maximum tumor diameter,lymph node metastasis,ascites cytology test results)of both groups were collected.Fasting venous blood was drawn from both groups before operation;D-Dimer,fibrinogen,carbohydrate antigen 125(CA125),neutrophil/lymphocyte ratio(NLR),human epididymal secretory protein 4(HE4),vascular endothelial growth factor(VEGF),soluble vascular endothelial growth factor receptor-1(sFLT1),CD105,carbohydrate antigen 19-9(CA19-9),and cytokeratin 19 fragment(CK19)were detected by Roche Cobas e601 automatic immune analyzer.Multivariate logistic method was used to analyze the comprehensive effect of each factor,and a nomogram prediction model was constructed;the ROC curve and computer simulation full sampling(bootstrap)method were used to verify the model.Results Thirteen(7.14%)of 182 patients with endometrioid adenocarcinoma had ovarian metastasis.Multivariate analysis of adjusted confounding factors showed that cervical involvement,lymphatic metastasis,positive ascites cytology,elevated D-dimer level,elevated CA125 level,elevated HE4 level,and elevated CK19 level were the influencing factors of ovarian metastasis in patients with endometrioid adenocarcinoma(P<0.05).The nomogram prediction model was established according to the results of multifactor analysis.The ROC analysis showed that the area under the curve(AUC)was 0.899,and 95%CI was 0.843 to 0.955.The bootstrap internal validation results showed that the average absolute error was 0.024,and the prediction model had a high degree of fit with the ideal model.Conclusion The influencing factors of ovarian metastasis of endometrioid adenocarcinoma include cervical involvement,lymphatic metastasis,positive cytological examination of ascites,elevated D-dimer level,elevated CA125 level,elevated HE4 level,and elevated CK19 level.The nomogram model constructed on this basis shows high accuracy and differentiation.It can be used to predict the risk of ovarian metastasis in patients with endometrioid adenocarcinoma.