摘要
目的观察采用卡铂为主的化疗方案治疗的上皮性卵巢癌患者血清循环肿瘤DNA(circulating tumor DNA, ctDNA)水平变化,探讨其与卡铂耐药的相关性及对预后的影响。方法上皮性卵巢癌患者95例,同期卵巢上皮良性囊肿患者50例,检测入院时血清ctDNA、癌抗原125(cancer antigen 125, CA125)水平。上皮性卵巢癌患者均行肿瘤细胞减灭术,术后采用以卡铂为主的足量化疗方案治疗至完全缓解。随访1年,23例出现卡铂耐药者为耐药组,余72例为敏感组,比较2组年龄,体质量指数,血清ctDNA、CA125水平,不同FIGO分期、分化程度、病理类型、化疗方案比率及难治性腹腔积液发生率等临床资料;多因素logistic回归分析上皮性卵巢癌患者发生卡铂耐药的影响因素;绘制ROC曲线,评估血清ctDNA预测上皮性卵巢癌患者发生卡铂耐药的价值;比较随访期间死亡的上皮性卵巢癌患者与生存者血清ctDNA水平。结果上皮性卵巢癌患者血清ctDNA[(585.63±52.36)μg/L]、CA125[(874.32±210.33)ku/L]水平均高于卵巢上皮良性囊肿患者[(202.33±35.85)μg/L、(289.01±85.40)ku/L](P<0.05)。耐药组血清ctDNA[(663.25±40.32)μg/L]、CA125[(1 256.28±255.36)ku/L]水平,FIGO分期Ⅲ~Ⅳ期比率(78.26%)、难治性腹腔积液发生率(26.09%)均高于敏感组[(560.68±32.58)μg/L、(752.30±200.38)ku/L、43.06%、6.94%](P<0.05),2组年龄、体质量指数、月经初潮年龄、孕次、产次、肿瘤残存直径、化疗周期,不同分化程度、病理类型、化疗方案及术前绝经、妇科恶性肿瘤家族史、吸烟、饮酒、双侧发病、术中清扫淋巴结比率比较差异均无统计学意义(P>0.05)。血清ctDNA(OR=3.504,95%CI:1.850~6.875,P<0.001)、血清CA125(OR=3.387,95%CI:1.798~6.527,P<0.001)、FIGO分期Ⅲ~Ⅳ期(OR=2.356,95%CI:1.701~5.532,P<0.001)、难治性腹腔积液(OR=2.793,95%CI:1.643~5.278,P<0.001)是上皮性卵巢癌患者发生卡铂耐药的影响因素。血清ctDNA、CA125分别以615.85μg/L
Objective To observe the level of circulating tumor DNA(ctDNA) of patients receiving carboplatin therapy for epithelial ovarian cancer, and to investigate its correlation with carboplatin resistance and its influence on the prognosis. Methods The serum levels of ctDNA and cancer antigen 125(CA125) were detected at admission in 95 patients with epithelial ovarian cancer and 50 patients with ovarian epithelial benign cyst. All patients with epithelial ovarian cancer were treated with carboplatin-based chemotherapy after cytoreductive surgery, and were divided into carboplatin-resistant group(n=23) and carboplatin-sensitive group(n=72) according to the one-year follow-up result. The clinical data as the age, body mass index, serum ctDNA level, CA125 level, percentages of FIGO stage, degree of differentiation, pathological type and chemotherapy regimen, and incidence of refractory ascites were compared between two groups. Multivariate logistic regression was used to analyze the influencing factors of carboplatin resistance in patients with epithelial ovarian cancer. ROC curve was drawn to evaluate the efficiency of serum ctDNA on predicting carboplatin resistance in patients with epithelial ovarian cancer.The serum level of ctDNA was compared between died and survived patients with epithelial ovarian cancer during follow-up.Results The levels of serum ctDNA and CA125 were higher in patients with epithelial ovarian cancer((585.63±52.36)μg/L,(874.32±210.33)ku/L)than those in patients with benign ovarian epithelial cyst((202.33±35.85)μg/L,(289.01±85.40)ku/L)(P<0.05).The serum ctDNA level,CA125 level,percentage of FIGO stage Ⅲ-Ⅳ and incidence of refractory ascites were higher in carboplatin-resistant group((663.25±40.32)μg/L,(1 256.28±255.36)ku/L,78.26%,26.09%)than those in carboplatin-sensitive group((560.68±32.58)μg/L,(752.30±200.38)ku/L,43.06%,6.94%)(P<0.05).There were no significant differences in the age,body mass index,age at menarche,gravidity,parity,diameter of residual tumor,cycle of chemotherapy
作者
董莉丽
杨然
李松
冯磊
DONG Li-li;YANG Ran;LI Song;FENG Lei(Department of Gynecology,Nanyang Central Hospital,Nanyang,Henan 473000,China)
出处
《中华实用诊断与治疗杂志》
2021年第9期881-885,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划(182102311190)。
关键词
上皮性卵巢癌
循环肿瘤DNA
癌抗原125
卡铂
化疗耐药
epithelial ovarian cancer
circulating tumor DNA
cancer antigen 125
carboplatin
chemotherapy resistance
