乳腺癌易感基因联合癌抗原125动态监测在预测晚期上皮性卵巢癌病人铂敏感性及预后中的价值  

Value of dynamic monitoring of breast cancer susceptibility genes combined with cancer antigen 125 in predicting platinum sensitivity and prognosis of advanced epithelial ovarian cancer patients

作　　者：韩姗姗 马玲[1] HAN Shanshan;MA Ling(Department of Gynecology Tumor,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233000,China)

机构地区：[1]蚌埠医学院第一附属医院肿瘤妇科,安徽蚌埠233000

出　　处：《安徽医药》2024年第1期159-164,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的评估胚系乳腺癌易感基因(BRCA)联合动态监测血清癌抗原125(CA125)在晚期上皮性卵巢癌(EOC)病人初治铂敏感性预测及判断预后中的价值。方法收集并回顾性分析2017年1月至2020年1月在蚌埠医学院第一附属医院行满意减瘤术且术后采用TC(紫杉醇+卡铂)/TP(紫杉醇+顺铂)方案静脉化疗的EOC病人151例的临床病理资料。分析胚系BRCA与EOC病人临床病理特征之间的关系;计算曲线下面积(AUC)值等评估胚系BRCA、治疗早期血清CA125水平及两者联合预测晚期EOC病人初治铂敏感性的效能;分析胚系BRCA、治疗早期血清CA125与晚期EOC病人无进展生存期(PFS)的关系;并对所有EOC病人的PFS进行多因素生存分析。结果胚系BRCA致病突变率为28.5%(43/151)。胚系BRCA与确诊年龄、治疗前血清CA125、遗传性乳腺癌和卵巢癌(HBOC)家族史等具有相关性(P<0.05);胚系BRCA、第一周期化疗后血清CA125单独预测晚期EOC病人初治铂敏感性的AUC为0.63、0.76;胚系BRCA与第一周期化疗后血清CA125串联预测晚期EOC病人初治铂敏感性的效能最高,AUC为0.79,95%CI:(0.69,0.90),灵敏度为69.7%,特异度为89.2%;在晚期EOC病人中,BRCA野生型+第一周期化疗后CA125>35 U/mL组病人的PFS生存曲线显著低于BRCA突变型+第一周期化疗后CA125≤35 U/mL组、BRCA突变型+第一周期化疗后CA125>35 U/mL组、BRCA野生型+第一周期化疗后CA125≤35 U/mL组(P=0.013、0.007、0.003)。多因素Cox回归分析显示第一周期化疗后血清CA125水平是EOC病人肿瘤无进展生存时间(PFS)的独立预后因素。结论胚系BRCA联合血清CA125动态监测对晚期EOC病人铂敏感性及预后有一定的预测价值。胚系BRCA野生型且第一周期化疗后血清CA125水平未正常提示EOC病人铂耐药及易复发的风险高。Objective To evaluate the value of germline breast cancer susceptibility gene(BRCA)combined with dynamic monitor⁃ing of serum cancer antigen 125(CA125)in predicting primary platinum sensitivity and determining prognosis in patients with ad⁃vanced epithelial ovarian cancer(EOC).Methods The clinicopathological data of EOC patients who underwent satisfactory subtrac⁃tive surgery together with postoperative intravenous chemotherapy with the TC(paclitaxel+carboplatin)/TP(paclitaxel+cisplatin)regi⁃men in the First Affiliated Hospital of Bengbu Medical College from January 2017 to January 2020 were collected and retrospectively analyzed.The relationship between germline BRCA and clinicopathological features of EOC patients was analyzed.The area under the curve(AUC)values were calculated to assess the efficacy of germline BRCA,serum CA125 levels in the early stage of treatment,and the combination of the two in predicting primary platinum sensitivity in patients with advanced EOC.To analyze the relationship be⁃tween germline BRCA,early treatment serum CA125 and progression-free survival(PFS)in patients with advanced EOC;and to per⁃form a multifactorial survival analysis of PFS in all EOC patients.Results Germline BRCA pathogenic mutation rate was 28.5%(43/151).The germline BRCA was correlated with age at diagnosis,pretreatment serum CA125,and family history of hereditary breast and ovarian cancer(HBOC)(P<0.05).The AUCs of germline BRCA and postfirst-cycle chemotherapy serum CA125 alone for predicting primary platinum sensitivity in patients with advanced EOC were 0.63 and 0.76,respectively.The tandem combination of germline BRCA and postfirst-cycle chemotherapy serum CA125 had the highest efficacy in predicting primary platinum sensitivity in patients with advanced EOC,with an AUC of 0.79,a 95%CI of(0.69,0.90),a sensitivity of 69.7%and specificity of 89.2%.In patients with ad⁃vanced EOC,the PFS survival curves of patients in the BRCA wild-type+postfirst-cycle chemotherapy serum CA125>35 U/mL group were signi

关 键 词：卵巢肿瘤 基因 BRCA1 基因 BRCA2 CA125抗原 抗药性 肿瘤 预后 铂敏感性 

分 类 号：R737.31[医药卫生—肿瘤]