新辅助化疗联合间歇性肿瘤细胞减灭术对上皮性卵巢癌患者预后及血清学与影像学指标对患者预后的预测价值  

Prognosis of neoadjuvant chemotherapy combined with interval cytoreductive surgery and predictive value of serological and imaging indicators for optimal cytoreductive surgery in patients with epithelial ovarian cancer

作　　者：何欣林 阎昊铮 赵亦非 江彩霞 李征宇 He Xinlin;Yan Haozheng;Zhao Yifei;Jiang Cairia;Li Zhengyu(Department of Obstetrics and Gynecology,Key Laboratory of Birth Defects and Related Disease of Women and Children,Ministry of Education,Reproductive Endocrinology and Regulation Laboratory,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西第二医院妇产科、出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2024年第1期47-57,共11页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：四川省自然科学基金项目(2023NSFSC0743)。

摘　　要：目的探讨上皮性卵巢癌(EOC)患者接受新辅助化疗(NACT)联合间歇性肿瘤细胞减灭术(CS)治疗后的预后情况,并对EOC患者血清学与影像学指标对初次肿瘤细胞减灭术(PCS)后肉眼可见病灶完全切除,无残留病灶(R0)的预测价值。方法选择2014年3月至2018年7月于四川大学华西第二医院接受NACT联合间歇性CS治疗的129例EOC患者为研究对象。根据PCS是否达R0,将其分别纳入R0组(n=72)与非R0组(n=57)。入院后,收集2组患者PCS前、后血清糖类抗原125(CA_(125))水平、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)等血清学指标,以及超声或CT检查的肿块最大径等影像学指标,分别采用CA_(125)-1、NLR-1、LMR-1、PLR-1、肿块最大径-1,以及CA_(125)-2、NLR-2、LMR-2、PLR-2、肿块最大径-2表示,对PCS前、后检查结果变化值,则采用CA_(125)-ratio、NLR-ratio、LMR-ratio、PLR-ratio、肿块最大径-ratio表示,并采用Mann-Whitney U检验进行比较。绘制血清学与影像学指标预测EOC患者PCS达R0的受试者工作特征(ROC)曲线,并确定其预测的最佳临界值,计算各指标单一与联合预测EOC患者PCS达R0的预测效能。采用Cox比例风险回归分析,对R0组与非R0组、不同周期NACT满足血清学与影像学指标联合诊断标准EOC患者的总体生存(OS)与无进展生存(PFS)率进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①R0组患者的OS率(60.0%)较非R0组(28.6%)高,并且差异有统计学意义(HR=0.370,95%CI:0.194~0.703,P=0.002)。R0组PFS率(40.3%)与非R0组(54.4%)比较,差异无统计学意义(P=0.122)。②R0组与非R0组EOC患者CA_(125)-ratio、NLR-2和LMR-2分别比较,差异均有统计学意义(Z=-3.09、-2.14、-2.40,P=0.002、0.033、0.017),2组PLR-Ratio比较,差异无统计学意义(P=0.912)。③绘制CA_(125)-ratio、1-NLR-2、LMR-2及肿块最大径-ratio预测EOC患�Objective To investigate the prognosis of neoadjuvant chemotherapy(NACT)combined with interval cytoreductive surgery(CS)in treatment of patients with epithelial ovarian cancer(EOC),and analyze the predictive value of serological and imaging indicators in EOC patients for reaching macroscopic residual lesion naught(R0)after primary cytoreductive surgery(PCS).Methods A total of 129 EOC patients who underwent NACT combined with interval CS in West China Second University Hospital,Sichuan University from March 2014 to July 2018 were enrolled as research subjects.Patients were enrolled into R0 group(n=72)and non-R0 group(n=57)according to whether the patients reached R0 after PCS.The serological indicators of two groups were collected,including the serum level of carbohydrate antigen 125(CA_(125)),neutrophil-to-lymphocyte ratio(NLR),lymphocyte-monocyte ratio(LMR),platelet-to-lymphocyte ratio(PLR)and the image indicator(maximum diameter of tumor on ultrasound or CT examination)of patients before and after PCS.Results of examinations before PCS was recorded as CA_(125)-1,NLR-1,LMR-1,PLR-1 and maximum diameter-1,and results of examinations after PCS was recorded as CA_(125)-2,NLR-2,LMR-2,PLR-2 and maximum diameter-2.The change values between them were recorded as CA_(125)-ratio,NLR-ratio,LMR-ratio,PLR-ratio,and maximum diameter-ratio.Mann-Whitney U test was used for comparison of these indicators between the R0 and non-R0 groups.The receiver operating characteristic(ROC)curve of serological and imaging indicators in predicting R0 in PCS of EOC patients was plotted,and the optimal cut-off value for prediction was determined.The prediction performance of single and combined indicators in predicting R0 in PCS of EOC patients was calculated.Cox proportional hazards regression analysis was used to compare the overall survival(OS)and progression-free survival(PFS)curves of EOC patients in the R0 and non-R0 groups and patients under different NACT cycles that met the combined diagnostic criteria of serological and imaging indic

关 键 词：卵巢肿瘤 新辅助化疗 肿瘤细胞减灭术 CA-125抗原 中性粒细胞与淋巴细胞比值 淋巴细胞与单核细胞比值 血小板与淋巴细胞比值 妇女 

分 类 号：R737.31[医药卫生—肿瘤]