摘要
目的观察卵巢癌患者疾病进展情况,检测其卵巢癌组织程序性死亡受体配体-1(programmed death ligand 1,PD-L1)和术后1周血清癌抗原-125(cancer antigen-125,CA-125)水平,探讨卵巢癌组织PD-L1表达情况和血清CA-125水平早期预测卵巢癌患者疾病进展的价值。方法行卵巢癌根治术患者104例,采用免疫组织化学法检测卵巢癌组织PD-L1表达情况,采用化学发光法检测患者术后1周血清CA-125水平;并以中位PD-L1表达情况分为PD-L1高表达(PD-L1>7分)组52例和PD-L1低表达(PD-L1≤7分)组52例,以中位血清CA-125水平分为CA-125高水平(CA-125>62.47 u/mL)组52例和CA-125低水平(CA-125≤62.47 u/mL)组52例,采用Kaplan-Meier生存曲线分析PD-L1高表达组和PD-L1低表达组、CA-125高水平组和CA-125低水平组患者疾病进展情况。随访5年,根据疾病进展情况分为疾病进展组和未进展组,比较2组临床资料;采用多因素COX比例风险回归模型分析卵巢癌患者疾病进展的影响因素;绘制ROC曲线,评估PD-L1、CA-125单独和联合检测早期预测卵巢癌疾病进展的效能。结果104例患者随访期间失访11例,93例中未出现疾病进展37例(未进展组),疾病进展56例(疾病进展组),疾病进展率为60.22%;PD-L1高表达组5年疾病进展率(74.47%)明显高于PD-L1低表达组(45.65%)(P<0.05),CA-125高水平组5年疾病进展率(72.34%)高于CA-125低水平组(47.83%)(P<0.05);疾病进展组肿瘤直径[(5.31±0.52)cm]大于未进展组[(4.33±0.57)cm](P<0.05),低分化比率(67.86%)、FIGO分期Ⅲ~Ⅳ期比率(75.00%)、肿瘤组织PD-L1表达评分[9(4,12)分]和术后1周血清CA-125水平[(77.35±10.78)u/mL]高于未进展组[40.54%、37.84%、6(0,8)分、(60.23±7.99)u/mL](P<0.05);肿瘤分化程度(HR=1.339,95%CI:1.169~1.535,P<0.001)、FIGO分期(HR=1.315,95%CI:1.158~1.493,P<0.001)、肿瘤组织PD-L1表达情况(HR=6.632,95%CI:1.831~24.028,P=0.004)及术后1周血清CA-125水平(HR=1.194,95%CI:1.034~1.379,P=0.016)是卵巢癌患者疾病进展的影响因素;当PD-L1、CA-125最佳截断值分别为7.64分、63.71 u/mL时,其单独及联合检测早期预测卵巢癌患者疾病进展的AUC分别为0.774(95%CI:0.676~0.855,P<0.001)、0.670(95%CI:0.564~0.764,P=0.013)、0.897(95%CI:0.816~0.950,P=0.026),灵敏度分别为55.36%、62.50%、96.43%,特异度分别为91.89%、72.97%、75.68%。结论卵巢癌组织PD-L1和术后血清CA-125水平检测可早期评估卵巢癌疾病进展风险。
Objective To investigate the values of programmed death-ligand 1(PD-L1)and cancer antigen-125(CA-125)to the early prediction of disease progression in patients with ovarian cancer by observing the progression of ovarian cancer and detecting the levels of PD-L1 in ovarian cancer tissue and serum CA-125 one week after operation.Methods Totally 104 patients underwent radical resection of ovarian cancer.Immunohistochemical method was used to detect the expression of PD-L1 in ovarian cancer tissues,and chemiluminescence method was used to detect the serum CA-125 level of patients one week after operation.The patients were divided into 52 patients with PD-L1>7(PD-L1 high-expression group)and 52 patients with PD-L1≤7(PD-L1 low-expression group),and were divided into 52 patients with CA-125>62.47 u/mL(CA-125 high-level group)and 52 patients with CA-125≤62.47 u/mL(CA-125 low-level group).The Kaplan-Meier survival curve was used to analyze the disease progression in PD-L1 high-and low-expression groups,and in CA-125 high-and low-level groups.And according to the disease progression in 5-year follow-up,the patients were divided into disease progression group and no-progression group,and were compared their clinical data.Multivariate COX risk proportional regression model was used to analyze the influencing factors of the disease progression of ovarian cancer,and ROC was drawn to evaluate the efficacies of detection of PD-L1 and/or CA-125 on predicting the progression of ovarian cancer.Results In 104 patients,11 patients were lost in the follow-up,37 of 93 patients had no disease progression(no-progression group)and 56 of 93 patients had disease progression(progression group),with a disease progression rate of 60.22%.The 5-year disease progression rate was higher in PD-L1 high-expression group(74.47%)than that in PD-L1 low-expression group(45.65%)(P<0.05),and in CA-125 high-level group(72.34%)than that in CA-125 low-level group(47.83%)(P<0.05).The diameter of the lesion was longer in disease progression group((5.31±0.52)cm)than that in no-progression group((4.33±0.57)cm)(P<0.05).The rate of poor differentiation(67.86%),the rate of FIGO stage Ⅲ-Ⅳ(75.00%),tumor tissue PD-L1 expression score(9(4,12))and serum CA-125 level one week after operation((77.35±10.78)u/mL)in progression group were higher than those in no-progression group(40.54%,37.84%,6(0,8),(60.23±7.99)u/mL)(P<0.05).The differentiation degree(HR=1.339,95%CI:1.169-1.535,P<0.001),the FIGO stage(HR=1.315,95%CI:1.158-1.493,P<0.001),the expression of PD-L1(HR=6.632,95%CI:1.831-24.028,P=0.004)and serum CA-125 level one week after operation(HR=1.194,95%CI:1.034-1.379,P=0.016)were the influencing factors of the progression of ovarian cancer.When the optimal cut-offvalues of PD-L1 and CA-125 level were 7.64 and 63.71 u/mL,the AUCs for early prediction of PD-L1,CA-125 and PD-L1+CA-125 were 0.774(95%CI:0.676-0.855,P<0.001),0.670(95%CI:0.564-0.764,P=0.013)and 0.897(95%CI:0.816-0.950,P=0.026),the sensitivities were 55.36%,62.50% and 96.43%,and the specificities were 91.89%,72.97%and 75.68%,respectively.Conclusion The detection of PD-L1 in ovarian cancer tissues and postoperative CA-125 level could early predict the risk of ovarian cancer disease progression.
作者
谢彦
王保庆
李庆妍
姜海英
XIE Yan;WANG Baoqing;LI Qingyan;JIANG Haiying(Department of Oncology,the Second Affiliated Hospital of Xuzhou Medical University,Xuzhou Mining Group General Hospital Xuzhou 221000 China;Department of Pharmacy the Second Affiliated Hospital of Xuzhou Medical University,Xuzhou Mining Group General Hospital Xuzhou 221000,China;Department of Oncology,Xuzhou Cancer Hospital,Xuzhou 221005,China)
出处
《中华实用诊断与治疗杂志》
2020年第12期1212-1216,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家科技支撑计划(2013BAI06B04)。
作者简介
通信作者:姜海英,E-mail:xzxy99@126.com。
