CA125动力学变化预测新辅助化疗晚期卵巢癌患者满意减瘤临床分析  

CA125 kinetic changes predict optimal cytoreduction in patients with neoadjuvant chemotherapy advanced ovarian cancer

作　　者：李胜霞 朱晨辰[3] 张安娜 倪丽 周颖 Li Shengxia;Zhu Chenchen;Zhang Anna(Anhui Provincial Hospital Affiliated to Anhui Medical University,Hefei 230001;The PLA Navy Anqing Hospital,Anqing 246003;The First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Sciences and Technology of China,Hefei 230001;The First People's Hospital of Huoqiu County,Liuan 237400)

机构地区：[1]安徽医科大学附属省立医院,合肥230001 [2]海军安庆医院,安庆246003 [3]中国科学技术大学附属第一医院(安徽省立医院),合肥230001 [4]霍邱县第一人民医院,六安237400 [5]寿县县医院,淮南232200

出　　处：《现代妇产科进展》2022年第10期745-750,共6页Progress in Obstetrics and Gynecology

基　　金：安徽省重点研发项目(No:2022e07020013);北京科创基金会重点项目(No:KC2021-JX-0186-143);2020年中国科学技术大学附属第一医院医疗领先技术引进项目(No:2020LXJS-05)。

摘　　要：目的:通过比较晚期卵巢癌患者新辅助化疗(NACT)期间多种CA125的动力学变化,分析其对中间型肿瘤细胞减灭术减瘤满意程度的预测价值。方法:搜集2018年1月1日至2021年12月31日在中国科学技术大学附属第一医院(安徽省立医院)接受新辅助化疗及中间型肿瘤细胞减瘤灭术的晚期卵巢癌患者的临床信息,获得人口统计学资料、治疗期间血清CA125水平,影像学资料、术后病理、治疗情况等信息,统计CA125的各项动力学变化,并分析其对预测满意减瘤可能性的预测价值。结果:共纳入66例患者,其中49例(74.24%)患者手术后无肉眼病灶残留(R0),17例(25.76%)存在病灶残留(R1/RX)。单因素分析中,NACT前、第一次NACT后、第三次NACT后CA125水平以及第一次NACT后CA125下降百分比在两组中存在差异(P分别为0.001、0.035、0.032、0.018)。多因素分析中,第三次NACT后CA125水平以及第一次NACT后CA125下降百分比为满意减瘤的显著预测因子(P=0.026,P=0.027)。根据ROC曲线,第三次NACT后CA125水平<33.34U/mL预测满意减瘤术具有更高的AUC(AUC=0.688)。生存分析中,第一次NACT后CA125下降百分比≥55.9%与患者更高的PFS及OS显著相关(P=0.001,P=0.046)。结论:对于晚期上皮性卵巢癌患者,第三次NACT后CA125水平<33.34 U/mL可成为满意性中间型减瘤术的潜在预测因子,而第一次NACT后CA125下降百分比≥55.9%与接受新辅助化疗及中间型减瘤术患者更优的生存预后显著相关。Objective:To compare the multiple dynamic changes of CA125 in patients with advanced ovarian cancer during neoadjuvant chemotherapy(NACT),and to analyze its predictive value for the satisfaction of interval debulking surgery(IDS).Methods:The clinical information of patients with advanced ovarian cancer who received neoadjuvant chemotherapy and IDS were collected between January 1,2018 and December 31,2021 in the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Sciences and Technology of China,containing demographic data,serum CA125 level during treatment,imaging data,postoperative pathology,treatment situation and other information.Then we statistical analyze of the kinetic changes of CA125 and assess the value of those to predict the possibility of satisfactory cytoreduction.Results:A total of 66 patients were included in this study,of which 49 patients(74.24%)had no gross lesion residue(R0)and 17 patients(25.76%)had lesion residue(R1/RX).In univariate analysis,the level of CA125 before NACT,after the first NACT,after the third NACT and the percentage of CA125 decrease after the first NACT were significantly different between the two groups(P values were 0.001,0.035,0.032 and 0.018 respectively).In multivariate analysis,the level of CA125 after the third NACT and the percentage of CA125 decrease after the first NACT were significant predictors of optimal cytoreduction(P=0.026,P=0.027).According to the ROC curve,the level of CA125<33.34U/mL after the third NACT predicted optimal cytoreduction with a higher AUC(AUC=0.688).However,according to the survival analysis,the percentage of CA125 decrease≥55.9%after the first NACT was significantly correlated with higher PFS and OS(P=0.001,P=0.046).Conclusion:CA125 level<33.34U/mL after the third NACT can be a potential predictor of optimal IDS,and the percentage of CA125 decrease≥55.9%after the first cycle is significantly related to a better survival prognosis of patients receiving NACT and IDS.

关 键 词：CA125 中间型减瘤术 新辅助化疗 卵巢癌 

分 类 号：R737.31[医药卫生—肿瘤]