术前淋巴细胞与单核细胞比值联合CA125在上皮性卵巢癌预后评估中的作用-现代医学

术前淋巴细胞与单核细胞比值联合CA125在上皮性卵巢癌预后评估中的作用

单位：1. 盐城市第二人民医院妇科, 江苏盐城 224000;
2. 阜宁县人民医院妇科, 江苏盐城 224400;
3. 复旦大学附属妇产科医院妇科, 上海 200011

分类号：R446.1

出版年·卷·期（页码）：2021·49·第十一期（1262-1266）

摘要：

目的：评估术前淋巴细胞与单核细胞比值（LMR）联合血清糖链抗原125（CA125）对上皮性卵巢癌（EOC）患者预后的预测价值，分层探讨LMR-CA125作为EOC患者预后指标的价值。方法：回顾性选取2015年1月至2019年12月于盐城市第二人民医院妇科初治的EOC患者120例。术前计算LMR，绘制受试者工作特征（ROC）曲线确定LMR、CA125界值和分组，结合随访生存情况分析LMR-CA125与EOC患者临床病理因素及预后的关系。结果：（1）LMR、CA125最佳预测界值分别为3.9、37.5 U·ml^-1。患者分为3组：0分组（LMR≥3.9，CA125<37.5 U·ml^-1），1分组[（LMR≥3.9，CA125≥37.5 U·ml^-1）或（LMR<3.9，CA125<37.5 U·ml^-1）]，2分组（LMR<3.9，CA125≥37.5 U·ml^-1）。LMR-CA125判断患者预后的ROC曲线下面积（AUC）大于单指标LMR、CA125（Z=3.027，P=0.003；Z=2.997，P=0.003）。（2）年龄、FIGO分期、分化程度及淋巴结转移在LMR-CA125不同分组间比较，差异均有统计学意义（均P<0.05）。（3）Cox回归多因素分析显示，FIGO分期（Ⅲ-Ⅳ vs.Ⅰ-Ⅱ，HR=5.680，95% CI：2.557～12.616，P<0.001）、分化程度（差vs.中-好，HR=5.265，95% CI：2.787～9.945，P<0.001）、淋巴结转移（是vs.否，HR=1.989，95% CI：1.152～3.432，P=0.014）及LMR-CA125（2分组vs. 0分组，HR=5.006，95% CI：2.587～9.687，P<0.001）是影响EOC患者预后的独立危险因素。结论：LMR-CA125可作为EOC患者预后的有效预测指标，高LMR-CA125提示患者预后不良。

Objective: To investigate the prognostic value of preoperative lymphocyte to monocyte ratio (LMR) combined with serum carbohydrate antigen 125 (CA125) in patients with epithelial ovarian cancer (EOC), and to explore the value of LMR-CA125 as a prognostic indicator for EOC patients. Methods: From January 2015 to December 2019, 120 EOC patients in Yancheng Second People's Hospital were enrolled in this study. LMR was calculated before operation, receiver operating characteristic (ROC) curve was drawn to determine the cut-off value and grouping of LMR and CA125. The relationship between LMR-CA125 and clinicopathological factors for prognosis of EOC patients was analyzed in combination with follow-up survival. Results:(1) The cut-off values of LMR and CA125 were 3.9 and 37.5 U·ml^-1, respectively. Patients were divided into three groups: group 0 (LMR≥3.9, CA125<37.5 U·ml^-1), group 1 [(LMR≥3.9, CA125≥37.5 U·ml^-1) or (LMR<3.9, CA125<37.5 U·ml^-1)], and group 2 (LMR<3.9, CA125≥37.5 U·ml^-1)]. The area under curve (AUC) of LMR-CA125 was higher than that of LMR and CA125 (Z=3.027, P=0.003; Z=2.997, P=0.003). (2) There were significant differences in age, FIGO stage, degree of differentiation and lymph node metastasis among different groups of LMR-CA125 (all P<0.05).(3) Multivariate Cox regression analysis showed that FIGO stage (Ⅲ-Ⅳ vs.Ⅰ-Ⅱ, HR=5.680, 95% CI: 2.557-12.616, P<0.001), differentiation degree (poor vs. moderate-good, HR=5.265, 95%CI: 2.787-9.945, P<0.001), lymph node metastasis (yes vs. no, HR=1.989, 95% CI: 1.152-3.432, P=0.014) and LMR-CA125 (group 2 vs. group 0, HR=5.006, 95% CI: 2.587-9.687, P<0.001) were independent risk factors for the prognosis of EOC patients. Conclusion:LMR-CA125 can be used as an effective predictor of the prognosis of EOC patients. High LMR-CA125 indicates poor prognosis.

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