治疗前血清CA125测定在临床早期子宫内膜癌中的价值

发布时间：2019-05-27 13:21

【摘要】：目的：分析早期子宫内膜癌患者治疗前血清CA125水平与临床病理特征的相关性及评估术前CA125能否做为确定分期手术范围及程度以及术后治疗的依据。 方法：回顾性收集了2010年11月至2014年1月于我院就诊的299例子宫内膜癌患者资料。共纳入诊断为临床早期子宫内膜癌且初始治疗为手术的226例患者。根据术后组织学分级及国际妇产科联盟2009分期，将其分为高危组（85例）和中低危组（141例）两组。分析了治疗前CA125水平与早期子宫内膜患者临床病理特征的相关性及其预测早期子宫内膜癌危险因素及高风险患者的价值。 结果：治疗前血清CA125水平与疾病的FIGO分期、肌层浸润深度、治疗方式、附件受累有关（p＜0.05），，而与年龄、绝经状态、体重指数、淋巴结状态、脉管间隙受累、分型、组织学分级、腹水细胞学无相关性。治疗前CA125水平在高危组及中低危组间有显著统计学差异(X2=7.587, p=0.006)。低风险组无淋巴结转移，高危组淋巴结转移率为9.23%，两组间的淋巴结转移率有统计学差异（X2=8.361, p=0.004）。当CA125的截断值取35U/ml时，其预测高危患者的灵敏度、特异度、阳性预测值、阴性预测值及受试者工作特征曲线下面积分别为36.47%、80.14%、52.54%、67.66%及0.618。而当CA125的截断值为22U/ml时,其预测高危患者的灵敏度为60%，特异度为61.7%。单因素及多因素Logistic回归分析提示治疗前CA125水平、组织学分级、脉管间隙受累及肌层浸润深度均不是早期子宫内膜癌淋巴结转移的危险因素（p＞0.05），仅FIGO（2009）Ⅲ期及Ⅳ期是淋巴结转移的危险因素（p＜0.05）。用ROC曲线评价了CA125对早期子宫内膜癌危险因素的预测价值，提示CA125水平可预测淋巴结转移、深肌层浸润及附件受累，且预测附件受累的价值最高(AUC=0.923, p＜0.001)。 结论：治疗前CA125水平可能对早期高风险子宫内膜癌有一定的预测价值，但单独使用CA125的诊断准确性较低。CA125水平在早期子宫内膜癌中可预测淋巴结转移、深肌层浸润及附件受累，且预测附件受累的价值最高。因此，单独使用治疗前CA125水平来确定分期手术范围及程度以及术后治疗的证据不足。
[Abstract]:Objective: to analyze the correlation between serum CA125 level and clinicopathological features in patients with early endometrial cancer before treatment and to evaluate whether preoperative CA125 can be used as the basis for determining the scope and degree of staging and postoperative treatment. Methods: the data of 299 patients with endometrial cancer in our hospital from November 2010 to January 2014 were collected retrospectively. the data of 299 patients with endometrial cancer in our hospital from November 2010 to January 2014 were collected. A total of 226 patients with early clinical intimal cancer and initial treatment were included in the study. According to the postoperative histology grade and the 2009 stage of the International Union of Obstetrics and Gynecology, they were divided into two groups: high risk group (n = 85) and middle and low risk group (n = 141). The correlation between CA125 level before treatment and clinicopathological features of early endometrial patients and its value in predicting risk factors of early endometrial cancer and high risk patients were analyzed. Results: the level of serum CA125 before treatment was related to FIGO stage, depth of myenteric invasion, treatment mode and adnexal involvement, but related to age, menopausal status, body mass index, lymph node status, vascular space involvement and classification. There was no correlation between histologic grade and ascites Cytology. There was significant difference in CA125 level between high risk group and middle and low risk group before treatment (x2 鈮

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