血清调节性T细胞比率、癌胚抗原、人附睾分泌蛋白4联合预测卵巢癌患者临床转归的价值

Predictive value of serum Treg frequency combined with CEA and HE4 for the clinical outcome of ovarian cancer

摘要:

目的 探讨血清调节性T细胞（Treg）比率、癌胚抗原（CEA）、人附睾分泌蛋白4（HE4）联合预测卵巢癌患者临床转归的价值。方法 回顾性分析2019年2月—2021年1月重庆医科大学附属第二医院和四川省肿瘤医院收治的98例卵巢癌患者（研究组），另取同期该院80例健康体检者作为对照组。检测所有研究对象的Treg比率、CEA及HE4水平。卵巢癌患者末次化疗结束后进行疗效评价，并依据临床转归情况分为完全缓解组（62例）和未完全缓解组（36例），对比其临床资料。采用逐步多因素Logistic回归模型分析卵巢癌患者临床转归的影响因素，受试者工作特征（ROC）曲线分析血清Treg比率、CEA、HE4及3者联合对卵巢癌患者临床转归的预测价值。结果 研究组Treg比率、CEA及HE4水平均高于对照组（P <0.05）。98例卵巢癌患者末次化疗结束后，完全缓解率为63.27%。未完全缓解组分化程度为低分化占比、淋巴结转移占比、术后残余病灶直径> 1 cm占比、未坚持全程化疗占比、血清Treg比率、CEA及HE4水平均高于完全缓解组（P <0.05）。逐步多因素Logistic回归分析结果显示，未坚持全程化疗［O^R=2.824（95% CI：1.052，4.375）］、血清Treg比率［O^R=2.843（95% CI：1.368，5.172）］、CEA［O^R=3.267（95% CI：2.046，7.815）］及HE4水平［O^R=3.618（95% CI：2.368，8.754）］是影响卵巢癌患者临床转归的危险因素（P <0.05）。ROC曲线结果显示，血清Treg比率、CEA、HE4及3者联合预测卵巢癌患者临床转归的敏感性分别为66.67%、72.22%、69.44%和63.89%，特异性分别为74.19%、69.35%、72.58%和96.77%，曲线下面积分别为0.738、0.751、0.674和0.904。结论 血清Treg比率、CEA、HE4 3者联合预测卵巢癌患者临床转归效能较高。

Abstract:

Objective To investigate the predictive value of serum regulatory T cell (Treg) frequency combined with carcinoembryonic antigen (CEA) and human epididymal secretory protein 4 (HE4) for the clinical outcome of ovarian cancer.Methods We retrospectively analyzed the clinical data of 98 ovarian cancer patients and 80 healthy volunteers who received physical examinations in the Second Affiliated Hospital of Chongqing Medical University and Sichuan Cancer Hospital from February 2019 to January 2021, and they were recorded as the study group and the control group, respectively. The Treg frequency, and CEA and HE levels were tested in all participants. Patients with ovarian cancer were evaluated after the last chemotherapy, and were divided into complete remission group (62 cases) and incomplete remission group (36 cases) based on the clinical outcome. The clinical characteristics of patients in the complete remission group and the incomplete remission group were compared. Multivariable Logistic regression model was applied to determine the factors affecting the clinical outcome of patients with ovarian cancer. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of the combination of serum Treg frequency, CEA and HE4 for the clinical outcome of ovarian cancer.Results The Treg frequency, and CEA and HE4 levels in the study group were higher than those in the control group (P < 0.05). After the last chemotherapy, the complete remission rate in 98 ovarian cancer patients was 63.27%. The proportions of poorly differentiated tumors, lymph node metastasis, residual lesions with a diameter > 1 cm after the operation, and the non-adherence to the whole course of chemotherapy, serum Treg frequency, and CEA and HE4 levels were higher in the incomplete remission group than those in the complete remission group (P < 0.05). Multivariable Logistic regression analysis showed that non-adherence to the whole course of chemotherapy [O^R = 2.824 (95% CI: 1.052, 4.375) ], serum Treg frequency [O^R = 2.843 (95% CI: 1.368, 5.172) ], CEA level [O^R = 3.267 (95% CI: 2.046, 7.815) ] and HE4 level [O^R = 3.618 (95% CI: 2.368, 8.754) ] were risk factors affecting the clinical outcome of ovarian cancer patients (P < 0.05). The receiver operating characteristic (ROC) curve analysis exhibited that the sensitivities of serum Treg frequency, CEA level, HE4 level and the combination of these indicators for predicting the clinical outcome of ovarian cancer were 66.67%, 72.22%, 69.44% and 63.89%, with the specificities being 74.19%, 69.35%, 72.58% and 96.77%, and the areas under the ROC curve (AUCs) being 0.738, 0.751, 0.674 and 0.904, respectively.Conclusions The combination of serum Treg frequency, CEA level and HE4 level exhibits relatively high efficacy in predicting the clinical outcome of patients with ovarian cancer.