术前三叶因子3、热休克蛋白40、中性粒细胞/淋巴细胞比值与上皮性卵巢癌患者肿瘤细胞减灭术后复发的关系

Relationship between Preoperative Trefoil Factor 3,Heat Shock Protein 40,Neutrophil/Lymphocyte Ratio and Postoperative Recurrence of Epithelial Ovarian Cancer Patients after Tumor Cell Reduction Surgery

目的:探讨术前三叶因子3(TFF3)、热休克蛋白40(HSP40)、中性粒细胞/淋巴细胞比值(NLR)与上皮性卵巢癌(EOC)患者肿瘤细胞减灭术(CRS)后复发的关系。方法:选取2016年1月~2017年5月南京市第二医院妇科收治的140例接受CRS治疗的EOC患者,根据CRS后是否复发分为复发组和未复发组。检测和计算血清TFF3、HSP40、NLR。采用单因素和多因素Logistic回归分析EOC患者CRS后复发的影响因素,受试者工作特征(ROC)曲线分析EOC患者CRS后复发的预测价值。结果:随访5年,失访2例,138例EOC患者CRS后复发率为52.90%(73/138)。与未复发组比较,复发组国际妇产科联盟(FIGO)分期Ⅳ期、化疗疗程≥6个、术后残留灶为最大残留肿瘤直径≤1 cm(R1)比例更大,术前血清糖类抗原(CA)125、TFF3、HSP40、NLR升高(P<0.05)。多因素Logistic回归分析显示,肿瘤直径≥3 cm、低分化、FIGO分期Ⅳ期、术后残留灶为R1和TFF3、HSP40、NLR升高为EOC患者CRS后复发的独立危险因素(P<0.05)。ROC曲线分析显示,术前血清TFF3、HSP40、NLR单独与联合预测EOC患者CRS后复发的曲线下面积(AUC)分别为0.766、0.763、0.765、0.911,术前血清TFF3、HSP40、NLR联合预测EOC患者CRS后复发的AUC最大。结论:术前血清TFF3、HSP40、NLR升高与EOC患者CRS后复发独立相关,可能成为EOC患者CRS后复发的辅助预测指标,且三指标联合应用预测价值更高。

Objective:To investigate the relationship between preoperative trefoil factor 3(TFF3),heat shock protein 40(HSP40),neutrophil/lymphocyte ratio(NLR)and recurrence after tumor cell reduction surgery(CRS)in patients with epithelial ovarian cancer(EOC).Methods:140 EOC patients who received CRS treatment in Department of Gynecology of Nanjing Second Hospital from January 2016 to May 2017 were selected,and they were divided into recurrent group and non recurrent group based on whether they recurred after CRS.Serum TFF3,HSP40,and NLR were detected and calculated.Single factor and multivariate logistic regression were used to analyze the influencing factors of recurrence after CRS in EOC patients,and the predictive value of recurrence after CRS in EOC patients were analyzed by Subjects'Job Characteristics(ROC)Curve.Results:Following up for 5 years,2 cases were lost and 138 EOC patients had a recurrence rate of 52.90%(73/138)after CRS.Compared with the non recurrence group,the recurrence group had a higher proportion of International Federation of Obstetrics and Gynecology(FIGO)stage Ⅳ,chemotherapy courses≥6,and postoperative residual lesions with a maximum residual tumor diameter of≤1 cm(R1).The preoperative serum carbohydrate antigen(CA)125,TFF3,HSP40,and NLR were increased(P<0.05).Multivariate logistic regression analysis showed that tumor diameter≥3 cm,low differentiation,FIGO stage Ⅳ,residual lesions of R1 and TFF3 after surgery,HSP40,and increased NLR were independent risk factors for recurrence after CRS in EOC patients(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of preoperative serum TFF3,HSP40,and NLR alone and in combination predicted recurrence after CRS in EOC patients were 0.766,0.763,0.765,and 0.911,respectively.The AUC of preoperative serum TFF3,HSP40,and NLR combined predicted recurrence after CRS in EOC patients was the highest.Conclusion:Elevated levels of preoperative serum TFF3,HSP40,and NLR are independently associated with postoperative recurrence in EOC patients with CRS,and may serve as auxiliary predictive indicators for postoperative recurrence in EOC patients.The combined use of these three indicators has higher predictive value.