ⅡA/ⅡB期睾丸精原细胞瘤术后患者放疗前后肿瘤标志物、LMR动态变化及其对近期疗效的影响

Dynamic changes of tumor markers and lymphocyte-to-monocyte ratio in postoperative patients with stageⅡA/ⅡB testicular seminoma before and after radiotherapy and their impact on short-term efficacy

目的分析ⅡA/ⅡB期睾丸精原细胞瘤术后患者放疗前后肿瘤标志物、淋巴细胞/单核细胞比值(LMR)动态变化及其与放疗效果的关系。方法回顾性分析山西省肿瘤医院2012年7月至2020年7月收治的70例ⅡA/ⅡB期睾丸精原细胞瘤术后患者的临床资料,根据放疗近期疗效情况将患者分为有效组(n=16)和无效组(n=54)。记录并整理患者基线资料、放疗前后肿瘤标志物水平及LMR值,分析肿瘤标志物、LMR与放疗近期疗效的关系。结果肿瘤直径>40 mm、睾丸血管浸润是影响ⅡA/ⅡB期睾丸精原细胞瘤术后患者放疗近期效果的危险因素(P<0.05)。有效组放疗后血清乳酸脱氢酶(LDH)水平低于放疗前,LMR值高于放疗前(P<0.05);无效组放疗前、后血清LDH水平高于有效组,LMR值低于有效组(P<0.05)。两组放疗前、后血清甲胎蛋白(AFP)、人绒毛膜促性腺激素(hCG)水平比较及组内比较,差异均无统计学意义(P>0.05)。放疗前、后血清LDH水平与肿瘤直径、睾丸血管浸润均呈正相关(r>0,P<0.05);放疗前、后LMR值与肿瘤直径、睾丸血管浸润均呈负相关(r<0,P<0.05)。放疗前血清LDH水平、LMR值及联合预测放疗无效的曲线下面积均>0.7,联合预测的价值更高。结论睾丸精原细胞瘤患者术后血清LDH水平、LMR值与放疗近期疗效密切相关。

Objective To analyze the dynamic changes of tumor markers,lymphocyte-to-monocyte ratio(LMR)before and after radiotherapy in patients with stageⅡA/ⅡB testicular seminoma after surgery,and the relationship between them and the efficacy of radiotherapy.Methods The clinical data of postoperativepatients with stageⅡA/ⅡB testicular seminoma treated in Shanxi Provincial Cancer Hospital from July 2012 toJuly 2020 were retrospectively analyzed.According to the short-term efficacy status of radiotherapy,the patientswere divided into effective group(n=16)and ineffective group(n=54).The baseline data of patients,tumormarkers and LMR levels before and after radiotherapy were recorded and sorted out,and the relationship betweentumor markers,LMR and short-term efficacy of radiotherapy was analyzed.Results Tumor diameter>40 mmand testicular vascular invasion were the risk factors affecting the short-term effect of radiotherapy in patientswith stageⅡA/ⅡB testicular seminoma after surgery(P<0.05).Serum lactate dehydrogenase(LDH)afterradiotherapy in the effective group was lower than that before radiotherapy,and LMR was higher than that beforeradiotherapy(P<0.05).The serum LDH of the ineffective group before and after radiotherapy was higher thanthat of the effective group,and the LMR value was lower than that of the effective group(P<0.05).There wasno statistically significant difference in the levels of serum alpha fetoprotein(AFP)and human chorionicgonadotropin(hCG)before and after radiotherapy between the two groups and intra-group comparison(P>0.05).The serum LDH levels before and after radiotherapy were positively correlated with tumor diameter andtesticular vascular infiltration(r>0,P<0.05).LMR level before and after radiotherapy was negativelycorrelated with tumor diameter and testicular vascular infiltration(r<0,P<0.05).The area under the curveof serum LDH level,LMR value before radiotherapy,and combined prediction of ineffective radiotherapy wereall greater than 0.7,the value of combined prediction was relatively high.Conclusions The levels of serumLDH and LMR in patients with testicular seminoma after surgery are closely related to the short-term efficacy ofradiotherapy.【Key words】Testicular seminoma;Helical tomotherapy;Tumor markers;Lymphocyte-to-monocyteratio;Short-term efficacy.