| 邱小菊,李仁河,张庆余,周冬梅,张 颖.术前HE4、FOLR1、NLR联合监测在上皮性卵巢癌术后复发中的临床应用价值[J].,2022,(22):4268-4273 |
| 术前HE4、FOLR1、NLR联合监测在上皮性卵巢癌术后复发中的临床应用价值 |
| Clinical Application Value of Combined Monitoring of HE4、FOLR1 and NLR in Postoperative Recurrence of Epithelial Ovarian Cancer |
| 投稿时间：2022-06-08 修订日期：2022-06-28 |
| DOI：10.13241/j.cnki.pmb.2022.22.013 |
| 中文关键词: 上皮性卵巢癌 HE4 FOLR1 NLR 复发 预测价值 |
| 英文关键词: Epithelial ovarian cancer HE4 FOLR1 NLR Recurrence Predictive value |
| 基金项目:广东省湛江市非资助科技攻关计划项目（190710094541745）；广东省科技厅面上项目（2017A030313559） |
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| 中文摘要: |
| 摘要 目的：探讨术前人附睾蛋白4（HE4）、叶酸受体1（FOLR1）、中性粒细胞淋巴细胞比值（NLR）联合监测在上皮性卵巢癌（EOC）术后复发中的临床应用价值，并分析EOC术后复发的危险因素。方法：选取2018年4月~2019年9月期间广东医科大学附属第二医院收治的114例EOC患者纳为EOC组，EOC组根据术后有无复发分为未复发组（n=42）和复发组（n=72），选择同期在广东医科大学附属第二医院住院治疗的100例卵巢上皮良性肿瘤患者作为卵巢良性疾病组，另选广东医科大学附属第二医院体检中心的健康女性志愿者95例作为对照组。对比EOC组和卵巢良性疾病组术前、对照组体检当日的HE4、FOLR1、NLR。对比未复发组、复发组术前的HE4、FOLR1、NLR及其他临床资料。采用多因素Logistic回归分析EOC术后复发的危险因素，通过绘制受试者工作特征（ROC）曲线分析HE4、FOLR1、NLR单独或联合应用对EOC术后复发的预测价值。结果：EOC组、卵巢良性疾病组的HE4、FOLR1、NLR高于对照组，且EOC组高于卵巢良性疾病组（P<0.05）。复发组的HE4、FOLR1、NLR均高于未复发组（P<0.05）。复发组、未复发组在病理类型、临床分期、术中腹水细胞学检查结果、化疗周期、清扫淋巴结、组织分化程度、术后残留大小方面对比差异有统计学意义（P<0.05）。HE4偏高、FOLR1偏高、NLR偏高、临床分期Ⅲ ~ Ⅳ期、组织分化程度为低分化、病理类型为浆液性、术后残留大小>1 cm、术中腹水细胞学检查结果为阴性、未清扫淋巴结均为EOC术后复发的危险因素（P<0.05）。HE4、FOLR1、NLR这三项指标术前联合检测预测术后复发的曲线下面积（AUC）为0.911均高于各指标单独检测的0.777、0.782、0.770。结论：EOC患者术前HE4、FOLR1、NLR处于高水平，且术前联合检测HE4、FOLR1、NLR对于EOC术后复发具有一定的预测价值，同时应关注临床分期Ⅲ ~ Ⅳ期、组织分化程度为低分化、病理类型为浆液性、术后残留大小>1cm、术中腹水细胞学检查结果为阴性、未清扫淋巴结的EOC患者，给予相关干预，以降低术后复发几率。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical application value of combined monitoring of human epididymal protein 4 (HE4), folate receptor 1 (FOLR1) and neutrophil lymphocyte ratio (NLR) in postoperative recurrence of epithelial ovarian cancer (EOC), and to analyze the risk factors of postoperative recurrence of EOC. Methods: 114 patients with EOC who were treated in The Second Affiliated Hospital of Guangdong Medical University from April 2018 to September 2019 were selected as EOC group. The EOC group was divided into non-recurrence group (n=42) and recurrence group (n=72) according to whether there was postoperative recurrence. 100 patients with benign ovarian epithelial tumors hospitalized in The Second Affiliated Hospital of Guangdong Medical University in the same period were selected as the benign ovarian disease group. Another 95 healthy women in the physical examination center of The Second Affiliated Hospital of Guangdong Medical University were selected as the control group. HE4, FOLR1 and NLR were compared between the EOC group and the benign ovarian disease group before operation and the control group on the day of physical examination. The preoperative HE4, FOLR1, NLR and other clinical data of the non-recurrence group and the recurrence group were compared. Multivariate Logistic regression was used to analyze the risk factors for postoperative recurrence of EOC, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of HE4, FOLR1, and NLR alone or in combination for postoperative recurrence of EOC. Results: HE4, FOLR1 and NLR in EOC group and benign ovarian disease group were higher than those in control group, and EOC group was higher than those in benign ovarian disease group (P<0.05). HE4, FOLR1 and NLR in recurrence group were higher than those in non-recurrence group (P<0.05). There were significant differences between the recurrence group and the non-recurrence group in pathological type, clinical stage, intraoperative ascites cytology, chemotherapy cycle, cleaned lymph nodes, degree of tissue differentiation and postoperative residual size (P<0.05). High HE4, high FOLR1, high NLR, clinical stage III ~ IV, low differentiation of tissue differentiation, serous pathological type, postoperative residual size > 1 cm, negative intraoperative ascites cytology and uncleaned lymph nodes were all risk factors for postoperative recurrence of EOC (P<0.05). The area under the curve (AUC) of preoperative combined detection of HE4, FOLR1 and NLR for predicting postoperative recurrence was 0.911, which was higher than 0.777, 0.782 and 0.770 for each indexes alone. Conclusion: Preoperative HE4, FOLR1 and NLR are at high levels in patients with EOC, and preoperative combined detection of HE4, FOLR1 and NLR has certain predictive value for postoperative recurrence of EOC. Meanwhile, attention should be paid to EOC patients with clinical stage III ~ IV, low degree of tissue differentiation, serous pathological type, postoperative residual size >1 cm, negative intraoperative ascites cytology, and uncleaned lymph nodes, and relevant intervention should be given to reduce the incidence of postoperative recurrence. |
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