【摘要】：目的：分析早期子宮內(nèi)膜癌患者治療前血清CA125水平與臨床病理特征的相關(guān)性及評(píng)估術(shù)前CA125能否做為確定分期手術(shù)范圍及程度以及術(shù)后治療的依據(jù)。 方法：回顧性收集了2010年11月至2014年1月于我院就診的299例子宮內(nèi)膜癌患者資料。共納入診斷為臨床早期子宮內(nèi)膜癌且初始治療為手術(shù)的226例患者。根據(jù)術(shù)后組織學(xué)分級(jí)及國(guó)際婦產(chǎn)科聯(lián)盟2009分期，將其分為高危組（85例）和中低危組（141例）兩組。分析了治療前CA125水平與早期子宮內(nèi)膜患者臨床病理特征的相關(guān)性及其預(yù)測(cè)早期子宮內(nèi)膜癌危險(xiǎn)因素及高風(fēng)險(xiǎn)患者的價(jià)值。 結(jié)果：治療前血清CA125水平與疾病的FIGO分期、肌層浸潤(rùn)深度、治療方式、附件受累有關(guān)（p＜0.05），，而與年齡、絕經(jīng)狀態(tài)、體重指數(shù)、淋巴結(jié)狀態(tài)、脈管間隙受累、分型、組織學(xué)分級(jí)、腹水細(xì)胞學(xué)無(wú)相關(guān)性。治療前CA125水平在高危組及中低危組間有顯著統(tǒng)計(jì)學(xué)差異(X2=7.587, p=0.006)。低風(fēng)險(xiǎn)組無(wú)淋巴結(jié)轉(zhuǎn)移，高危組淋巴結(jié)轉(zhuǎn)移率為9.23%，兩組間的淋巴結(jié)轉(zhuǎn)移率有統(tǒng)計(jì)學(xué)差異（X2=8.361, p=0.004）。當(dāng)CA125的截?cái)嘀等?5U/ml時(shí)，其預(yù)測(cè)高�；颊叩撵`敏度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及受試者工作特征曲線下面積分別為36.47%、80.14%、52.54%、67.66%及0.618。而當(dāng)CA125的截?cái)嘀禐?2U/ml時(shí),其預(yù)測(cè)高�；颊叩撵`敏度為60%，特異度為61.7%。單因素及多因素Logistic回歸分析提示治療前CA125水平、組織學(xué)分級(jí)、脈管間隙受累及肌層浸潤(rùn)深度均不是早期子宮內(nèi)膜癌淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素（p＞0.05），僅FIGO（2009）Ⅲ期及Ⅳ期是淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素（p＜0.05）。用ROC曲線評(píng)價(jià)了CA125對(duì)早期子宮內(nèi)膜癌危險(xiǎn)因素的預(yù)測(cè)價(jià)值，提示CA125水平可預(yù)測(cè)淋巴結(jié)轉(zhuǎn)移、深肌層浸潤(rùn)及附件受累，且預(yù)測(cè)附件受累的價(jià)值最高(AUC=0.923, p＜0.001)。 結(jié)論：治療前CA125水平可能對(duì)早期高風(fēng)險(xiǎn)子宮內(nèi)膜癌有一定的預(yù)測(cè)價(jià)值，但單獨(dú)使用CA125的診斷準(zhǔn)確性較低。CA125水平在早期子宮內(nèi)膜癌中可預(yù)測(cè)淋巴結(jié)轉(zhuǎn)移、深肌層浸潤(rùn)及附件受累，且預(yù)測(cè)附件受累的價(jià)值最高。因此，單獨(dú)使用治療前CA125水平來確定分期手術(shù)范圍及程度以及術(shù)后治療的證據(jù)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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