术后CA125值变化对上皮性卵巢癌预后判断的价值  

Exploratory analysis of serum CA125 response to surgery and the risk of relapse in patients with epithelial ovarian cancer

作　　者：唐洁[1] 王蕾[1] 

机构地区：[1]湖南省肿瘤医院妇瘤一科,湖南长沙410006

出　　处：《中国现代医学杂志》2012年第7期39-43,共5页China Journal of Modern Medicine

基　　金：湖南省自然科学基金面上项目(No:09JJ5012);国家自然科学基金项目(No:81101996)

摘　　要：目的探讨手术前后血清CA125值的变化对上皮性卵巢癌中的疗效和预后临床判断价值。方法采用回顾性分析方法,对2000年1月~2007年6月在该院妇瘤科初治的204例上皮性卵巢癌患者进行手术前后血清CA125的检测,计算术后CA125值较术前下降的百分比,观察CA125不同组复发中位时间及生存期限的差异。结果 204例患者中有80例复发,CA125下降≥75.0%组、50.0%~〈75.0%组、〈50.0%组各组复发的中位时间差异有显著性（χ2=10.422,P〈0.001）,CA125下降〈50.0%组和上升组的复发时间短。Kaplan-Meier法计算生存率,得出术后CA125值下降水平≥75.0%组的中位生存时间为52.4个月,50.0%~〈75.0%组为32.6个月,〈50.0%组为21.3个月,CA125上升组为10.3个月,中位时间差异有显著性（χ2=76.8,P〈0.001）。以log-rank时序检验比较各组生存率曲线的分布差异有显著性;对于满意肿瘤细胞减灭术的患者术后CA125下降幅度与疾病的进展呈负相关。COX风险模型分析上皮性卵巢癌预后的多因素。结果表明CA125下降水平、FIGO分期、术后残存病灶大小与卵巢上皮癌预后明显相关。结论术后CA125值与术前下降的百分比对上皮性卵巢癌的预后评定有一定的临床价值,该指标可协助判断复发,尽早予以相应的治疗措施.【Objective】 To analyze whether serum CA125 response to cytoreductive surgery before initiation of postoperative chemotherapy is associated with overall survival（OS） in patients with epithelial ovarian carcinoma.【Methods】 In this retrospective study,204 patients were included with paired pre-and postoperative CA125 measurements,who underwent primary cytoreductive surgery between 2000 and 2007 in Hunan Provincial Hospital.The association of perioperative CA125 changes with OS was investigated using a Kaplan-Meier analysis.【Results】 100 of 204 patients had a relapse.The median recurrent time was statistically different for 4 perioperative serum CA125 change groups：CA125 decline ≥75.0%,50.0%～75.0%,50% and increase（χ2=10.422,P 0.001）.It was much shorter for groups with CA125 declined 50.0% or increase than CA125 decline ≥75.0% or 50.0%～75.0%.The median survival time was also statistically different for 4 perioperative serum CA125 change groups： CA125 declined ≥75.0%（52.4 months,50%～75.0%（32.6 months）,50.0%（21.3 months） and increased（10.3 months）.Overall,perioperative serum CA125 changes were associated with OS by log-rank test.The risk of disease progression increased incrementally as the magnitude of the serum CA125 response to surgery decreased.This association was pronounced in optimally but not observed in suboptimally debulked patients.Through a COX proportional hazards model,a perioperative change of serum CA125 levels was found to be a prognostic factor as well as stage,residual tumor size for epithelial ovarian cancer.【Conclusion】 Perioperative serum CA125 changes are strongly associated with the risk of relapse in patients with optimally resected disease.This may be useful for patient counseling and risk stratification during subsequent clinical trials as well as for the development of novel prognostic models.

关 键 词：CA125 卵巢上皮性癌 术前术后CA125的变化 

分 类 号：R737.31[医药卫生—肿瘤]