细胞角蛋白19片段对子宫内膜癌保留卵巢的预测价值

发布时间：2018-05-05 15:56

  本文选题：子宫内膜癌 + 肿瘤标志物　； 参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:研究细胞角蛋白19片段(cytokeratin 19,CK19)与子宫内膜癌临床病理特征的关系,卵巢转移的预测价值及其对预后的影响。方法:采用回顾性病例对照研究的方法分析2010年11月至2016年6月在我院接受手术治疗的子宫内膜癌患者,共517例。分别测定血清癌抗原125(cancer antigen 125,CA125)、人附睾蛋白4(human epididymis protein 4,HE4)、糖链抗原19-9(carbohydrate antigen,CA19-9)、CK19水平,并计算卵巢恶性肿瘤发病风险模型(risk of ovarian malignancy algorithm,ROMA)指数,分析这些肿瘤标志物对卵巢转移的预测价值。应用Kaplan-Meier(K-M)法和COX比例风险回归模型进行生存分析,并采用log-rank检验进行验证。结果:(1)在所有患者中,CK193.3ng/mL(OR=4.233,95%CI1.673-10.714,P=0.002),CA125≥35u/mL(OR=13.076,95%CI4.254-40.189,P0.001)和Ⅱ型癌(OR=3.176,95%CI 1.222-8.259,P=0.018)是子宫内膜癌预测卵巢转移的独立预测因子。在绝经前亚组中,只有CK193.3ng/m L(OR=22.156,95%CI 1.324-370.857,P=0.031)和Ⅱ型癌(OR=11.992,95%CI 1.019-141.163,P=0.048)是预测卵巢转移的独立预测因子。(2)升高的CK19水平与淋巴脉管间隙浸润(P0.001),附件转移(P0.001),深肌层浸润(P0.001),Ⅱ型癌(P0.001)和FIGO2009晚期癌(P0.001)相关。CK19可以预测绝经前Ⅰ型癌的卵巢转移,当截断值为3.3ng/mL时,灵敏度、特异度、阳性及阴性预测值分别为66.7%,91.8%,26.7%和98.4%,曲线下面积为0.878。(3)COX风险比例回归模型证实CK19是无进展生存时间(progression free survival,PFS)的独立预后因素(HR=3.583,95%CI 1.391 9.226,P=0.008)。结论:纳入CK19作为子宫内膜癌术前评估的一部分,特别是有卵巢保留诉求的绝经前Ⅰ型癌患者,对临床医师制定合理手术策略有一定指导作用。
[Abstract]:Objective: to study the relationship between cytokeratin 19 (CK19) and clinicopathological features of endometrial carcinoma, the predictive value of ovarian metastasis and its influence on prognosis. Methods: a retrospective case-control study was conducted to analyze 517 patients with endometrial carcinoma who underwent surgical treatment in our hospital from November 2010 to June 2016. The levels of serum carcinoantigen 125(cancer antigen 125, human epididymal protein 4(human epididymis protein 4, carbohydrate antigen 19-9(carbohydrate antigenn CA19-9 and CK19 were measured, respectively. The risk of ovarian malignancy algorithm was calculated for the risk model of ovarian malignancy, and the predictive value of these tumor markers for ovarian metastasis was analyzed. Kaplan-Meiern K-M) method and COX proportional risk regression model were used for survival analysis, and the results were verified by log-rank test. Results: in all patients, CK193.3 ng / mLORT 4.23395 CI 1.673-10.714P0. 002 + CA125 鈮，

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