【作者】 陈艳；

【导师】 谢幸；

【作者基本信息】 浙江大学 ， 妇产科学， 2005， 硕士

【摘要】 背景 90%以上的卵巢恶性肿瘤为上皮性卵巢癌(epithelial ovarian cancer, EOC),75%左右患者初次诊断时为进展期,而对进展期EOC初次手术后辅以化疗的标准治疗方式已获得共识。若初次细胞减灭术残余灶达不到理想减灭,即残余灶≥2cm,这部分患者预后较差。近年来对不能达到理想减灭术的EOC,采用新辅助化疗和间隔手术已显示可提高理想减灭率和改善生活质量,因此术前准确预测能否达到理想减灭术非常重要。目前对如何术前判断能否达到理想减灭仍无理想的方法。 癌抗原125(cancer antigen 125, CA125)是EOC最常用的肿瘤标记物,虽然对EOC作为筛选或早期诊断血清CA125的作用有限,但对于已经确诊为EOC的患者,不失为追踪病情状况的一个良好指标,已有的一些研究提示血清CA125水平的升降与EOC的疾病状态密切相关。近年来,有学者对术前血清CA125水平能否预测初次手术结果进行了一些研究。有学者发现术前血清CA125水平与能否达到理想手术有关系,但也存在相反的结果,且能评判初次手术减灭结果的术前血清CA125阈值存在争议。 本研究回顾性分析62例原发性EOC患者术前测定的血清CA125值,与临床病理参数的关系以手术减灭的结果比较,探讨EOC患者术前血清CA125值与临床病理特征关系,以及能否预测理想手术及其可能合适的阈值。材料与方法 回顾性分析2000年10月～2003年8月于浙江大学医学院附属妇产科医院初次更多还原

【Abstract】 BackgroundAbout 90% of malignant ovarian neoplasm is epithelial ovarian cancer (EOC), and about 75% of EOC cases are recognized in advanced stages. We all know the basic way of therapy in EOC is primary cytoreduction and chemotherapy after surgery. If the residual rumor nodule remaining at the end of the surgery measured more than 2 cm, the prognosis of EOC is worse. The neoadjuvant chemotherapy and interval operation to the cases that would suffer the suboptimal primary cytoreducioncan can improve the success of surgery and quality of the life. So it is very important to predict if we can make optimal cytoreducion of advanced EOC before operation. But now there is not any optimal way to predict correctly.The role of rumor markers in monitoring of ovarian cancer is well established. Cancer antigen 125(CA125) has proved to be a useful tumor marker, the change of which is in much relation with the status of EOC. Recently, some literatures show the value of CA125 levels to ability in predicting the optimal primary cytoreduction, but some literatures don’t think so. And there is much dispute on the threshold of CA125.The aim of this study of 62 patients with EOC is to investigate of the relation of CA125 and some parameters of clinical pathology and the predictive value of serum CA125 levels to ability of optimal primary cytoreduction and the suitable threshold.Materials and MethodsRetrospective records study 62 patients with EOC with all stages (2000.10-2003.8). Study the relation between preoperative CA125 and some parameters of clinical pathology (age, histology, grade and FIGO stage). The ability of CA125 at threshold level of 500 U/ml 1000 U/ml and 1500 U/ml to predict suboptimal cytoreduction and get each sensitivity specificity positive predicative value (PPV), negative predicative value (NPV) accuracy and the suitable threshold.Results1 CA125 of early stage EOC is much lower than of advanced EOC, and there are statistical differences (X~2=15. 61, P<0. 05) at the threshold of 500u/ml. There is no difference among difference histology (X~2=1.36, P>0. 05) . There is no cases of grade I in 62 cases. And there is statistical differences of CA125 level in grade II and grade III (X2=11.24, P<0. 05) 2 At the CA125 threshold of 500u/ml the sensitivity for predicting suboptimal debulking is 78.57%, specificity is 64.71%, accuracy is 70.97%, PPV is 64. 71%,NPV is 78.57%. At the CA125 threshold of 500u/ml the sensitivity for predicting suboptimal debulking is 78.57 % and specificity is 61. 11% in forty-six patients of stage III or IV.3, At the CA125 thresholdl of 1000u/ml the sensitivity for predicting suboptimal debulking is 50.00%, specificity is 79.41%, accuracy is 66.13%, PPV is 66. 67%, NPV is 65.85%.4, At the CA125 thresholdl of 1500u/ml the sensitivity for predicting suboptimal debulking is 42.86%, specificity is 85.29%, accuracy is 66.13%, PPV is 70.59%,NPV is 64.44%.ConclusionsThere are some relations between CA125 level and some clinical pathological parameters. The preoperative serum CA125 level can predict the optimalcytoreduction of EOC The suitable threshold of CA125 is 500 u/ml. But the sensitivity and other index are not all perfect, so we should need use other ways simultaneous.更多还原