糖类抗原125动力学变化在卵巢癌初次肿瘤细胞减灭术患者预后评估中的应用研究

Application of kinetic changes of carbohydrate antigen 125 in prognostic evaluation of patients undergoing primary debulking surgery for ovarian cancer

目的探讨肿瘤标志物糖类抗原125(CA125)的血清动力学变化指标在行初次肿瘤细胞减灭术(PDS)的上皮性卵巢癌(EOC)患者治疗预后评估中的临床意义。方法回顾性分析2013年1月至2021年2月苏州大学附属第一医院妇产科收治的239例行PDS的EOC患者的临床信息及随访资料,统计CA125的各项动力学变化,并分析其对EOC患者治疗预后的预测价值。结果239例EOC患者的发病年龄(54.1±10.2)岁。其中PDS达到满意肿瘤细胞减灭术组214例(89.5%),未达到满意肿瘤细胞减灭术组25例(10.5%),满意PDS组患者的总生存期(OS)和无进展生存期(PFS)均显著高于不满意PDS组患者(P<0.0001和P=0.001)。单因素分析显示,腹水量、国际妇产科联盟(FIGO)分期、术后残余癌灶、术前CA125水平、血清CA125转阴所需化疗疗程数、血清CA125所达到最低值及血清CA125消除速率常数K(KELIM)值与患者的OS显著相关(P<0.05);多因素分析显示:FIGO分期、术后残余癌灶及KELIM值是预测OS的独立因素。结论血清CA125动力学变化指标中,KELIM值可以作为评估EOC患者预后的指标之一;术前血清CA125水平可作为判断能否实施满意PDS的一项重要指标。KELIM值算法较其他CA125相关变量纳入了更多的时间点,对EOC患者治疗预后更具预测价值。

Objective To explore the clinical significance of dynamic changes of serum carbohydrate antigen 125(CA125)level in the evaluation of treatment and prognosis of patients with epithelial ovarian cancer(EOC)undergoing primary debulking surgery(PDS).Methods The clinical information and follow-up data of 239 patients with EOC who underwent PDS admitted to the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Soochow University from January 2013 to February 2021 were analyzed retrospectively,the kinetic changes of CA125 were counted,and its value in predicting the prognosis of patients with EOC was analyzed.Results The average age of onset in 239 patients with EOC was(54.1±10.2)years.Among them,214 patients(89.5%)achieved satisfactory tumor reduction and 25 patients(10.5%)did not achieve satisfactory tumor reduction.The overall survival(OS)and progressionfree survival(PFS)of patients with satisfactory PDS were significantly higher than those of patients with unsatisfactory PDS(P<0.0001and P=0.001).Univariate analysis showed that amount of ascites,FIGO(International Federation of Gynecology and Obstetrics)stage,residual disease,preoperative CA125 level,cycles of chemotherapy required for CA125 to be negative,the minimum value of CA125 and the value of CA125 elimination rate constant K(KELIM)value were significantly correlated with OS(P<0.05);multivariate analysis showed that FIGO stage,residual disease,and the KELIM value were independent factors for predicting OS.Conclusion s serum CA125,the KELIM value can be used as one of the indexes to evaluate the prognosis of patients with EOC,and the preoperative CA125 level can be used as one of the important indexes to determine whether satisfactory PDS can be performed.The KELIM value algorithm includes more time points than other CA125 related variables,and is more valuable in predicting the treatment prognosis of EOC patients.