超声参数与卵巢癌患者病理特征、恶性程度及预后的关系

Relationship between Ultrasound Parameters and Pathological Characteristics,Malignant Degree and Prognosis of Ovarian Cancer Patients

目的分析超声参数与卵巢癌患者病理特征、恶性程度及预后的关系。方法选取2018年1月至2020年1月防城港市第一人民医院收治的120例行手术治疗的卵巢癌患者为研究对象。对比不同病理特征、不同恶性程度卵巢癌患者的超声参数[峰值流速(PSV)、舒张末期流速(EDV)、动脉血管搏动指数(PI)及阻力指数(RI)],采用Spearman分析超声参数与卵巢癌患者病理特征、恶性程度的相关性;采用受试者工作特征曲线(ROC曲线)分析超声参数对卵巢癌患者预后的评估价值;采用Cox风险比例回归模型分析影响卵巢癌患者预后的因素。结果肿瘤分化程度为中低分化、有淋巴结转移、国际妇产科联盟(FIGO)分期Ⅲ~Ⅳ期的卵巢癌患者PSV和EDV值高于肿瘤分化程度为高分化、无淋巴结转移、FIGO分期Ⅰ~Ⅱ期的卵巢癌患者(P<0.01),PI、RI值低于肿瘤分化程度为高分化、无淋巴结转移、FIGO分期Ⅰ~Ⅱ期的卵巢癌患者(P<0.01)。Spearman相关性分析显示,PSV、EDV与肿瘤分化程度呈负相关,与淋巴结转移、FIGO分期呈正相关(P<0.01);PI、RI与肿瘤分化程度呈正相关,与淋巴结转移、FIGO分期呈负相关(P<0.01)。ROC曲线分析结果显示,PSV、EDV、PI、RI水平预测卵巢癌患者死亡的最佳截断值分别为26.12 cm/s、16.47 cm/s、0.54、0.31,灵敏度分别为72.1%、79.3%、66.7%、85.5%,特异度分别为70.5%、67.7%、73.6%、75.4%。单因素分析显示,死亡组≥60岁、中低分化、具有残留癌、FIGO分期Ⅲ~Ⅳ期所占比例高于存活组,PSV、EDV值高于存活组,PI、RI值低于存活组(P<0.01)。多因素Cox回归分析显示,有残留癌、FIGO分期Ⅲ~Ⅳ期、PSV≥26.12 cm/s、EDV≥16.47 cm/s、PI<0.54、RI<0.31是影响卵巢癌患者预后的危险因素(HR=1.914,95%CI 1.253~2.574;HR=2.557,95%CI 1.448~3.667;HR=2.330,95%CI 1.246~3.451;HR=2.092,95%CI 0.943~3.240;HR=2.214,95%CI 1.311~3.118;HR=2.563,95%CI 1.184~3.941)(P<0.01)。结论PSV、EDV、PI及RI等超声参数与卵巢癌患者的病理特征、恶性程度及预后关系密切,可作为评估患者肿瘤恶性程度的参考依据,对卵巢癌患者的诊疗及预后具有较高的参考价值。

Objective To analyze the relationship between ultrasound parameters and pathological characteristics,malignant degree and prognosis of ovarian cancer patients.Methods A total of 120 ovarian cancer patients who underwent surgical treatment in Fangchenggang First People′s Hospital from Jan.2018 to Jan.2020 were included.The ultrasound parameters[peak systolic velocity(PSV),end-diastolic velocity(EDV)and pulse index(PI)and resistance index(RI)]of patients with different pathological characteristics and different malignant degrees of ovarian cancer were compared.Spearman was used to analyzed the correlation of the ultrasound parameters with the pathological characteristics and malignant degree;receiver operating characteristic curve(ROC curve)was used to evaluate the value of ultrasound parameters on the prognosis of ovarian cancer patients;Cox risk proportional regression model was used to analyze the factors affecting the prognosis of ovarian cancer patients.Results The PSV and EDV values of ovarian cancer patients with moderate to low differentiation,lymph node metastasis,and stageⅢ-Ⅳof the International Federation of Gynecology and Obstetrics(FIGO)staging were higher than those with high differentiation,no lymph node metastasis,and stageⅠ-Ⅱof the FIGO staging(P<0.01).The PI and RI values were lower than those with high differentiation,no lymph node metastasis,and stageⅠ-Ⅱof the FIGO staging(P<0.01).Spearman correlation analysis showed that PSV and EDV were negatively correlated with the degree of tumor differentiation,positively correlated with lymph node metastasis and FIGO stage(P<0.01);PI and RI were positively correlated with the degree of tumor differentiation,and negatively associated with lymph node metastasis and FIGO stage(P<0.01).ROC curve analysis showed that the optimal cut-off values predicted by PSV,EDV,PI,and RI were 26.12 cm/s,16.47 cm/s,0.54,0.31,respectively,with the sensitivity of 72.1%,79.3%,66.7%,85.5%,and the specificity of 70.5%,67.7%,73.6%,75.4%,respectively.Univariate analysis showed that the proportions of age≥60 years old,medium-low differentiation,with residual cancer,FIGO stageⅢ-Ⅳof death group were higher than those of survival group,PSV and EDV values were higher than those of survival group,and PI and RI values were lower than those of survival group(P<0.01).Multivariate Cox regression analysis showed that residual cancer,FIGO stageⅢ-Ⅳ,PSV≥26.12 cm/s,EDV≥16.47 cm/s,PI<0.54,RI<0.31 were risk factors affecting the prognosis of ovarian cancer patients(HR=1.914,95%CI 1.253-2.574;HR=2.557,95%CI 1.448-3.667;HR=2.330,95%CI 1.246-3.451;HR=2.092,95%CI 0.943-3.240;HR=2.214,95%CI 1.311-3.118;HR=2.563,95%CI 1.184-3.941)(P<0.01).Conclusion The ultrasound parameters such as PSV,EDV,PI and RI are closely related to the pathological characteristics,malignant degree and prognosis of the ovarian cancer patients,which can be used as a reference basis for evaluating the tumor malignant degree,and have high reference value for the diagnosis,treatment and prognosis of the patients.