B超联合肿瘤标志物对卵巢黏液性肿瘤恶变的预测价值研究

Prediction Value of B-ultrasound with Tumor Markers for Malignant Transformation of Mucinous Ovarian Tumors

背景卵巢黏液性肿瘤(MOT)根据病理结果可分为良性肿瘤如黏液性囊腺瘤(MCA)、交界性肿瘤如黏液性交界性肿瘤(MBT)及恶性肿瘤如黏液性癌(MC),最终确诊需依靠手术病理检查,术前鉴别诊断较为困难,提高术前诊断效能对于医生的诊断及患者治疗方案的选择尤为重要。目的探讨MOT恶变的高危因素,评估B超联合肿瘤标志物对MOT恶变的预测价值。方法选取2010—2020年在南京医科大学第一附属医院行手术治疗的414例MOT患者为研究对象,根据术后病理分为三组:MCA组(305例)、MBT组(79例)和MC组(30例)。收集患者的年龄、临床症状、B超表现(卵巢肿瘤大小、性质、是否有乳头、是否可探及血流信号、是否为多房肿瘤)及血清肿瘤标志物〔癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原199(CA199)、糖类抗原724(CA724)〕和D-二聚体水平。应用多因素Logistic回归分析探讨MOT恶变的危险因素,采用受试者工作特征曲线(ROC曲线)评估B超联合肿瘤标志物对MOT恶变的预测价值,并计算ROC曲线下面积(AUC)及其95%CI。结果三组患者B超表现及血清学指标比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,卵巢肿瘤最大径≥10 cm〔OR=1.947,95%CI(1.066,3.556),P=0.030〕,肿瘤内有实性成分〔OR=9.862,95%CI(4.465,21.782),P<0.001〕、乳头〔OR=2.320,95%CI(1.100,4.893),P=0.027〕、血流信号〔OR=2.289,95%CI(1.104,4.747),P=0.026〕,肿瘤表现为多房〔OR=5.722,95%CI(3.034,10.789),P<0.001〕及CA125≥35.0 U/mL〔OR=4.307,95%CI(1.963,9.452),P<0.001〕、CA199≥39.0 U/mL〔OR=2.227,95%CI(1.030,4.816),P=0.042〕是MOT恶变的独立危险因素。B超联合肿瘤标志物预测MOT恶变的AUC为0.868〔95%CI(0.825,0.912),P<0.001〕,最佳截断值为0.354,灵敏度为72.5%,特异度为90.8%。结论当卵巢肿瘤最大径≥10 cm,B超提示肿瘤内有实性成分、乳头、血流信号,肿瘤表现为多房及患者CA125≥35.0 U/mL、CA199≥39.0 U/mL时,需警惕MOT恶变的可能;B超联合肿瘤标志物对MOT恶变有一定的预测价值。

Background Mucinous ovarian tumors(MOT)can be divided into three types:benign〔such as mucinous cystadenoma(MCA)〕,borderline〔such as mucinous borderline tumor(MBT)〕,and malignant〔such as mucinous cystadenocarcinoma(MC)〕.It is difficult to differentiate between the types preoperatively,and the final diagnosis depends on surgical pathology.So how to reduce the difficulty in making a preoperative differential diagnosis,and improve the preoperative diagnostic accuracy is particularly important for doctors to make a diagnosis and for patients to choose a treatment option.Objective To explore the high-risk factors associated with malignant transformation of MOT,and to evaluate the predictive value of B-ultrasound combined with tumor markers for malignant transformation of MOT.Methods Retrospective observational study selected surgery-treated 414 women with a histologically confirmed MCA(n=305),MBT(n=79)and MC(n=30)from the First Affiliated Hospital with Nanjing Medical University during 2010 to 2020.Patients'data,including age,clinical symptoms,sonographic data(tumor size,properties,papilla-shaped protuberance on the cystic wall,blood flow signals,multilocular)and serum tumor markers〔carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199),carbohydrate antigen 724(CA724)〕and D-dimer were collected.Multivariate Logistic regression analysis was used to explore the risk factors of malignant transformation of MOT.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of B-ultrasound with tumor markers for malignant transformation of MOT,and the area under the curve(AUC)with the corresponding 95%CI were calculated.Results There were statistically significant differences in B-ultrasound manifestations and serological indicators among the three groups(P<0.05).Maximum diameter of the ovarian tumor≥10 cm〔OR=1.947,95%CI(1.066,3.556),P=0.030〕,solid tumor components〔OR=9.862,95%CI(4.465,21.782),P<0.001〕,papilla-shaped protuberance on the cystic wall〔OR=2.320,95%CI(1.100,4.893),P=0.027〕,blood flow signals〔OR=2.289,95%CI(1.104,4.747),P=0.026〕,multilocular morphology〔OR=5.722,95%CI(3.034,10.789),P<0.001〕,CA125≥35.0 U/mL〔OR=4.307,95%CI(1.963,9.452),P<0.001〕and CA199≥39.0 U/mL〔OR=2.227,95%CI(1.030,4.816),P=0.042〕were independently associated with increased malignant tendency of MOT.The optimal cut-off value of B-ultrasound with tumor markers〔AUC=0.868,95%CI(0.912,0.825),P<0.001〕in predicting the malignant transformation of MOT was 0.354,with 72.5%sensitivity and 90.8%specificity.Conclusion It is need to consider the possibility of malignant transformation of MOT when a patient is found with an ovarian tumor with maximum diameter≥10 cm with solid components,papilla-shaped protuberance on the cystic wall,blood flow signals,and multilocular morphology,as well as serum CA125≥35.0 U/mL and CAl99≥39.0 U/mL.B-ultrasound with tumor markers may partially predict the malignant transformation of MOT.