本文選題：子宮內(nèi)膜癌 + 腫瘤標(biāo)志物��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究細(xì)胞角蛋白19片段(cytokeratin 19,CK19)與子宮內(nèi)膜癌臨床病理特征的關(guān)系,卵巢轉(zhuǎn)移的預(yù)測價值及其對預(yù)后的影響。方法:采用回顧性病例對照研究的方法分析2010年11月至2016年6月在我院接受手術(shù)治療的子宮內(nèi)膜癌患者,共517例。分別測定血清癌抗原125(cancer antigen 125,CA125)、人附睪蛋白4(human epididymis protein 4,HE4)、糖鏈抗原19-9(carbohydrate antigen,CA19-9)、CK19水平,并計(jì)算卵巢惡性腫瘤發(fā)病風(fēng)險模型(risk of ovarian malignancy algorithm,ROMA)指數(shù),分析這些腫瘤標(biāo)志物對卵巢轉(zhuǎn)移的預(yù)測價值。應(yīng)用Kaplan-Meier(K-M)法和COX比例風(fēng)險回歸模型進(jìn)行生存分析,并采用log-rank檢驗(yàn)進(jìn)行驗(yàn)證。結(jié)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)是子宮內(nèi)膜癌預(yù)測卵巢轉(zhuǎn)移的獨(dú)立預(yù)測因子。在絕經(jīng)前亞組中,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)是預(yù)測卵巢轉(zhuǎn)移的獨(dú)立預(yù)測因子。(2)升高的CK19水平與淋巴脈管間隙浸潤(P0.001),附件轉(zhuǎn)移(P0.001),深肌層浸潤(P0.001),Ⅱ型癌(P0.001)和FIGO2009晚期癌(P0.001)相關(guān)。CK19可以預(yù)測絕經(jīng)前Ⅰ型癌的卵巢轉(zhuǎn)移,當(dāng)截?cái)嘀禐?.3ng/mL時,靈敏度、特異度、陽性及陰性預(yù)測值分別為66.7%,91.8%,26.7%和98.4%,曲線下面積為0.878。(3)COX風(fēng)險比例回歸模型證實(shí)CK19是無進(jìn)展生存時間(progression free survival,PFS)的獨(dú)立預(yù)后因素(HR=3.583,95%CI 1.391 9.226,P=0.008)。結(jié)論:納入CK19作為子宮內(nèi)膜癌術(shù)前評估的一部分,特別是有卵巢保留訴求的絕經(jīng)前Ⅰ型癌患者,對臨床醫(yī)師制定合理手術(shù)策略有一定指導(dǎo)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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