Ⅱb~Ⅳ期上皮性卵巢癌肿瘤细胞减灭术结局的术前预测模型构建  

Preoperative prediction nomogram model construction for cytoreductive surgery outcome of stageⅡb-Ⅳepithelial ovarian cancer

作　　者：努尔斯曼古丽·艾力 祖菲娅·艾力[1] Nuersimanguli AILI;Zufeiya AILI(Department of Gynecology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830000,China)

机构地区：[1]新疆医科大学第一附属医院妇科,新疆维吾尔自治区乌鲁木齐830000

出　　处：《中华实用诊断与治疗杂志》2022年第5期483-487,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆维吾尔自治区科技计划项目(2016E02069)。

摘　　要：目的术前应用CT评估的腹膜癌指数(peritoneal cancer index,PCI)(CT-PCI)和血清糖类抗原125(carbohydrate antigen 125,CA125)、人附睾蛋白4(human epididymis protein 4,HE4)等临床指标构建列线图模型,探讨其预测Ⅱb~Ⅳ期上皮性卵巢癌患者肿瘤细胞减灭术(减瘤术)结局的价值。方法Ⅱb~Ⅳ期上皮性卵巢癌患者161例,均行初始减瘤术。术前2周内行腹盆腔CT检查,评估PCI。根据减瘤术结局是否满意,将161例患者分为满意组92例和不满意组69例。记录2组年龄,ASA分级,术前血清CA125、HE4、白蛋白水平和中性粒细胞计数、淋巴细胞计数、中性粒细胞/淋巴细胞比值(neutrophils to lymphocytes ratio,NLR)、血小板/淋巴细胞比值(platelet to lymphocyte ratio,PLR)、单核细胞/淋巴细胞比值(monocyte to lymphocyte ratio,MLR)、全身炎症反应指数(systemic inflammation response index,SIRI);多因素logistic回归分析Ⅱb~Ⅳ期上皮性卵巢癌患者减瘤术结局不满意的影响因素;绘制ROC曲线,评估CT-PCI、血清CA125、血清HE4、SIRI预测Ⅱb~Ⅳ期上皮性卵巢癌患者减瘤术结局不满意的价值;根据多因素logistic回归分析结果,建立预测Ⅱb~Ⅳ期上皮性卵巢癌患者减瘤术结局不满意的列线图模型,采用ROC曲线及校准曲线评估该模型的预测价值。结果满意组ASA分级Ⅲ级(15.2%)、中大量腹腔积液(48.9%)比率,NLR[3.25(2.55,4.38)],SIRI[1.56(1.09,2.39)×10^(9)/L],CT-PCI[(10.40±1.70)分]及血清CA125[(316.15±262.25)u/mL]、HE4[(156.14±118.15)pmol/L]水平均低于不满意组[69.6%、73.9%、3.45(2.23,5.43)、3.33(1.84,5.47)×10^(9)/L、(13.65±2.03)分、(623.44±350.04)u/mL、(366.19±338.80)pmol/L](P<0.05),淋巴细胞计数[1.58(1.29,1.85)×10^(9)/L]、血清白蛋白[(36.25±2.34)g/L]水平均高于不满意组[1.32(0.98,1.78)×10^(9)/L、(31.62±2.71)g/L](P<0.05),年龄、中性粒细胞计数、PLR、MLR与不满意组比较差异均无统计学意义(P>0.05)。CT-PCI(OR=5.931,95%CI:2.307~15.246,P<0.0Objective To construct a predictive nomogram model based on peritoneal cancer index(PCI)on preoperative CT and clinical indicators as carbohydrate antigen 125(CA125)and human epididymis protein 4(HE4),and to investigate its value to the prediction of cytoreductive surgery outcome in patients with stageⅡb-Ⅳepithelial ovarian cancer.Methods Totally 161patients with stageⅡb-Ⅳepithelial ovarian cancer underwent cytoreductive surgery 2weeks after abdominal CT scan to evaluate PCI,and were divided into satisfactory group(n=92)and unsatisfactory group(n=69)according to patients’satisfactory to cytoreductive surgery outcome.The age,ASA grade,and preoperative levels of serum CA125,HE4,albumin,neutrophil,lymphocyte,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to lymphocyte ratio(MLR)and systemic inflammatory response index(SIRI)were recorded.Multivariate logistic regression was done to analyze the influencing factors of unsatisfactory outcome,and ROC curve was drawn to evaluate the values of CT-PCI,serum CA125,serum HE4and SIRI to the prediction of unsatisfactory outcome.Based on the results of multivariate logistic regression analysis,a nomogram model was constructed to predict unsatisfactory outcome of stageⅡb-Ⅳepithelial ovarian cancer.The predictive value of the model was evaluated by ROC curve and calibration curve.Results The percentages of patients with ASA gradeⅢ(15.2%)and mass ascites(48.9%),NLR[3.25(2.55,4.38)],SIRI[1.56(1.09,2.39)×10^(9)/L],CT-PCI(10.40±1.70),serum CA125[(316.15±262.25)u/mL]and HE4[(156.14±118.15)pmol/L]in satisfactory group were lower than those in unsatisfactory group[69.6%,73.9%,3.45(2.23,5.43),3.33(1.84,5.47)×10^(9)/L,13.65±2.03,(623.44±350.04)u/mL,(366.19±338.80)pmol/L](P<0.05),the lymphocyte count[1.58(1.29,1.85)×10^(9)/L]and serum albumin level[(36.25±2.34)g/L]were higher than those in unsatisfactory group[1.32(0.98,1.78)×10^(9)/L,(31.62±2.71)g/L](P<0.05),and there were no significant differences in the age,neutrophil count,PLR

关 键 词：上皮性卵巢癌 肿瘤细胞减灭术 腹膜癌指数 CT 列线图模型 

分 类 号：R737.31[医药卫生—肿瘤]