DWI定量指标联合血清学指标对卵巢癌淋巴结转移早期诊断价值

Analysis of the value of DWI quantitative indexes combined with serological indexes for early diagnosis of lymph node metastasis in ovarian cancer

目的分析良性卵巢肿瘤、卵巢癌患者之间及有无淋巴结转移卵巢癌患者之间扩散加权成像(DWI)定量指标、血清学指标的区别,并探讨上述指标对卵巢癌淋巴结转移早期诊断价值。方法选择2020-04-01-2023-05-30开封市肿瘤医院行手术治疗的卵巢癌患者78例为病例组,以年龄±5岁选择同期接诊的卵巢良性上皮肿瘤患者78例为对照组。患者均行DWI检查,计算表观弥散系数(ADC)平均值;并对血清学指标糖类抗原125(CA125)、糖类抗原199(CA199)、血管内皮生长因子-C(VEGF-C)及β_(2)微球蛋白(β_(2)-MG)进行检测。用t检验比较2组DWI定量指标及血清学指标,病例组患者根据有无淋巴结转移分为淋巴结转移组与无淋巴结转移组,进行t检验比较2组患者各指标,并以受试者工作特征(ROC)曲线分析法评估各指标单独检测与联合检测对卵巢癌淋巴结转移的早期诊断价值。结果病例组患者ADC值为(1.29±0.37)×10^(-3)mm^(2)/s,低于对照组的(1.77±0.49)×10^(-3)mm^(2)/s,差异有统计学意义,t=6.904,P<0.001;病例组患者CA125、CA199、VEGF-C、β_(2)-MG水平分别为(1821.07±288.19)U/mL、(117.06±23.97)U/mL、(2401.88±122.73)pg/mL和(4.03±0.74)mg/L,高于对照组的(41.02±7.33)U/mL、(17.43±4.82)U/mL、(1721.28±98.17)pg/mL和(1.88±0.52)mg/L,差异有统计学意义,t值分别为-54.533、-35.988、-38.246和-20.995,均P<0.001。淋巴结转移组患者ADC值为(0.76±0.22)×10^(-3)mm^(2)/s,低于无淋巴结转移组的(1.54±0.37)×10^(-3)mm^(2)/s,差异有统计学意义,t=9.739,P<0.001;淋巴结转移组患者CA125、CA199、VEGF-C、β_(2)-MG水平分别为(1892.43±297.04)U/mL、(130.31±25.88)U/mL、(2892.32±124.21)pg/mL和(4.56±0.72)mg/L,高于无淋巴结转移组的(1787.41±153.88)U/mL、(110.81±22.71)U/mL、(2170.54±99.83)pg/mL和(3.78±0.66)mg/L,差异有统计学意义,t值分别为-2.062、-3.383、-27.513和-4.731,均P<0.001。logistic回归分析结果显示,ADC值(OR=0.453,95%CI为0.255~0.804,P=0.007)、CA125(OR=2.487,95%CI为1.336~4.629,P=0.004)、CA199(OR=2.542,95%CI为1.308~4.940,P=0.006)、VEGF-C(OR=2.389,95%CI为1.335~4.276,P=0.003)及β_(2)-MG(OR=2.177,95%CI为1.357~3.492,P=0.001)均与卵巢癌淋巴结转移具有相关性。ROC曲线分析结果显示,ADC值、CA125、CA199、VEGF-C及β_(2)-MG对卵巢癌淋巴结转移诊断的AUC分别为0.747、0.936、0.754、0.752、0.715,5者联合诊断的AUC为0.951,其诊断效能高于各指标单独检测,P<0.001。结论ADC值、CA125、CA199、VEGF-C及β_(2)-MG均与卵巢癌淋巴结转移具有相关性,各指标均可用于卵巢癌淋巴结转移的早期诊断,联合检测可提高诊断效能。

Objective To analyse the differences in quantitative diffusion-weighted imaging(DWI)indexes and serological indexes between patients with benign ovarian tumors and ovarian cancer and between patients with or without lymph node metastasis of ovarian cancer,and to explore the value of the above indexes for the early diagnosis of lymph node metastasis of ovarian cancer.Methods Seventy-eight patients with ovarian cancer who underwent surgical treatment at Kaifeng Cancer Hospital from April 1,2020 to May 30,2023 were selected as the case group,and 78 patients with benign epithelial ovarian tumors who were treated at the same period of time and within±5 years of age were selected as the control group.The patients were subjected to DWI examination,and the mean apparent diffusion coefficient(ADC)value was calculated;and the serological indicators such as carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199),vascular endothelial growth factor C(VEGF-C)andβ_(2)-microglobulin(β_(2)-MG)were detected.Thet-test was used to compare the quantitative indexes of DWI and serological indicators of the two groups.The patients in the case group were divided into lymph node metastasis group and non-lymph node metastasis group according to the presence or absence of lymph node metastasis,and the t-test was performed to compare the indexes of the two groups.The receiver operating characteristic(ROC)curve analysis method was used to evaluate the early diagnostic value of each indicator alone and in combination for lymph node metastasis in ovarian cancer.Results The ADC value of patients in the case group was(1.29±0.37)×10^(-3)mm^(2)/s,which was lower than that of(1.77±0.49)×10^(-3)mm^(2)/s in the control group,the difference was statistically significant,t=6.904,P<0.001.The levels of CA125,CA199,VEGF-C,andβ_(2)-MG in patients in the case group were(1821.07±288.19)U/ml,(117.06±23.97)U/ml,(2401.88±122.73)pg/ml,and(4.03±0.74)mg/L,respectively,which were higher than those in the control group of(41.02±7.33)U/ml,(17.43±4.82)U/ml,(1721.28±98.17)pg/ml and(1.88±0.52)mg/L,the difference was statistically significant,with t-values of-54.533,-35.988,-38.246,and-20.995,respectively,with all P<0.001.The ADC value of patients in the lymph node metastasis group was(0.76±0.22)×10^(-3)mm^(2)/s,which was lower than that of the group without lymph node metastasis.which was(0.54±0.37)×10^(-3)mm^(2)/s,the difference was statistically significant,t=9.739,P<0.001.The levels of CA125,CA199,VEGF-C,andβ_(2)-MG in the patients in the lymph node metastasis group were(1892.43±297.04)U/ml,(130.31±25.88)U/ml,(2892.32±124.21)pg/ml,and(4.56±0.72)mg/L,respectively,which were higher than those in the group without lymph node metastasis(1787.41±153.88)U/ml,(110.81±22.71)U/ml,(2170.54±99.83)pg/ml and(3.78±0.66)mg/L,the difference was statistically significant,with t-values of-2.062,-3.383,-27.513,and-4.731,respectively,all P<0.001.The results of logistic regression analysis showed that ADC values(OR=0.453,95%CI:0.255-0.804,P=0.007),CA125(OR=2.487,95%CI:1.336-4.629,P=0.004),CA199(OR=2.542,95%CI:1.308-4.940,P=0.006),VEGF-C(OR=2.389,95%CI:1.335-4.276,P=0.003)andβ_(2)-MG(OR=2.177,95%CI:1.357-3.492,P=0.001)were all correlated with lymph node metastasis in ovarian cancer.The results of ROC curve analysis showed that the AUC of ADC value,CA125,CA199、VEGF-C andβ_(2)-MG for the diagnosis of lymph node metastasis of ovarian cancer were 0.747,0.936,0.754,0.752,0.715,respectively,and the AUC of the combination of the five was 0.951,which had a diagnostic efficacy higher than that of each index detected individually,with P<0.001.Conclusion ADC,CA125,CA199,VEGF-C andβ_(2)-MG are all correlated with lymph node metastasis of ovarian cancer,and they can be used for the early diagnosis of lymph node metastasis of ovarian cancer,and the combination of the tests can improve the diagnostic efficacy.