乳腺癌改良根治术患者术后复...FR-P55的预测价值研究_李慧芳.pdf

现代生物医学进展Progress in Modern Biomedicine Vol.23NO.2JAN.2023doi:10.13241/ki.pmb.2023.02.034乳腺癌改良根治术患者术后复发转移的危险因素及血清 CA125、COX-2、sTNFR-P55 的预测价值研究*李慧芳地力木拉提 艾斯木吐拉郭晨明热菲拉 买买提买吐鲁佰 米尔扎合买提潘新枝（新疆医科大学第一附属医院乳腺外科 新疆 乌鲁木齐 830000）摘要 目的：探讨乳腺癌改良根治术患者术后复发转移的危险因素及血清糖类抗原 125（CA125）、环加氧酶-2（COX-2）、可溶性肿瘤坏死因子受体 P55（sTNFR-P55）的预测价值。方法：对 2014 年 1 月至 2016 年 12 月新疆医科大学第一附属医院收治的 109 例行乳腺癌改良根治术的乳腺癌患者进行前瞻性研究，所有患者术后均随访 5 年，其中 2 例失访，107 例完成随访。根据 5 年内患者复发转移情况将其分为复发转移组（n=31）和未复发转移组（n=76）。收集患者入院时的临床病理资料，采用电化学发光法检测术前血清 CA125，采用酶联免疫吸附法检测术前血清 COX-2、sTNFR-P55。采用 logistic 回归模型分析患者术后复发转移的影响因素，绘制受试者工作特征（ROC）曲线评估血清 CA125、COX-2、sTNFR-P55 对术后复发转移的预测价值。结果：复发转移组肿瘤直径5 cm、浸润性非特殊癌、脉管癌栓、雌激素受体（ER）/孕激素受体（PR）阴性、无内分泌治疗构成比、TNM 分期 IIIA 期、腋窝淋巴结转移数量 49 个构成比高于未复发转移组（P0.05）。复发转移组血清 CA125、COX-2、sTNFR-P55 水平高于未复发转移组（P0.05）。多因素 logistic 回归分析结果显示，肿瘤直径5 cm、浸润性非特殊癌、TNM 分期 IIIA 期、脉管癌栓、腋窝淋巴结转移数量 49 个、CA125 升高、COX-2 升高、sTNFR-P55 升高是乳腺癌改良根治术患者术后 5 年内复发转移的独立危险因素（OR=1.318、1.213、1.223、1.137、1.257、1.241、1.313、1.351，P0.05）。血清 CA125、COX-2、sTNFR-P55 均可有效预测乳腺癌术后复发转移，曲线下面积（AUC）分别为 0.803、0.749、0.761，三指标联合预测术后复发转移的 AUC 为 0.915，灵敏度和特异度分别为 0.94、0.83。结论：肿瘤直径、浸润性非特殊癌、TNM 分期、脉管癌栓、腋窝淋巴结转移数量以及术前血清 CA125、COX-2、sTNFR-P55 异常升高是乳腺癌改良根治术患者术后 5 年内复发转移的危险因素，术前血清 CA125、COX-2、sTNFR-P55 联合检测可预测乳腺癌改良根治术后的复发转移风险。关键词：乳腺癌；改良根治术；复发；转移；CA125；COX-2；sTNFR-P55；预测价值中图分类号：R737.9文献标识码：A文章编号：1673-6273（2023）02-384-06Risk Factors of Recurrence and Metastasis in Patients with Breast Cancerafter Modified Radical Mastectomy and Predictive Value Study of SerumCA125,COX-2 and sTNFR-P55*LI Hui-fang,Aisimutula Dilimulati,GUO Chen-ming,Maimaiti Refeila,Mierzhaheti Maitulubai,PAN Xin-zhi(Department of Breast Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830000,China)ABSTRACT Objective:To study the risk factors of recurrence and metastasis in patients with breast cancer after modified radicalmastectomy and the predictive value of serum carbohydrate antigen 125(CA125),cyclo-oxygenase-2(COX-2),soluble tumor necrosisfactor receptor-P55(sTNFR-P55).Methods:109 patients with breast cancer who underwent modified radical mastectomy in The FirstAffiliated Hospital of Xinjiang Medical University from January 2014 to December 2016 were prospectively studied.All patients werefollowed up for 5 years after operation,including 2 patients who were lost to follow-up,and 107 patients who completed follow-up.According to the recurrence and metastasis within 5 years,the patients were divided into recurrence and metastasis group(n=31)andnon-recurrence and metastasis group(n=76).The clinicopathological data of the patients at admission were collected.Preoperative serumCA125 was detected by electrochemiluminescence method,and preoperative serum COX-2 and sTNFR-P55 were detected byenzyme-linked immunosorbent assay.Logistic regression model was used to analyze the influencing factors of postoperative recurrenceand metastasis,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum CA125,COX-2and sTNFR-P55 on postoperative recurrence and metastasis.Results:The tumor diameter greater than 5cm,invasive non-specific carci-*基金项目：新疆维吾尔自治区自然科学基金面上项目（2017D01C302）作者简介：李慧芳（1988-），女，硕士，住院医师，主要从事乳腺良恶性疾病诊治方向的研究，E-mail:通讯作者：地力木拉提 艾斯木吐拉（1968-），男，硕士，主任医师，主要从事乳腺良恶性疾病诊治方向的研究，E-mail:（收稿日期：2022-07-10 接受日期：2022-08-08）384现代生物医学进展Progress in Modern Biomedicine Vol.23NO.2JAN.2023noma,vascular tumor thrombus,estrogen receptor(ER)/progesterone receptor(PR)negative,the constituent ratio of no endocrine therapy,TNM stage IIIA,and the number of axillary lymph node metastases 49 in the recurrence and metastasis group were higher than those inthe non-recurrence and metastasis group(P0.05).The levels of serum CA125,COX-2 and sTNFR-P55 in the recurrence and metastasisgroup were higher than those in the non-recurrence and metastasis group(P0.05).Multivariate logistic regression analysis showed thattumor diameter greater than 5cm,invasive non-specific carcinoma,TNM stage IIIA,vascular tumor thrombus,number of axillary lymphnode metastases 49,increased CA125,increased COX-2,and increased sTNFR-P55 were independent risk factors for recurrence andmetastasis within 5 years after modified radical mastectomy(OR=1.318,1.213,1.223,1.137,1.257,1.241,1.313,1.351,P0.05).SerumCA125,COX-2 and sTNFR-P55 could effectively predict postoperative recurrence and metastasis of breast cancer,and the area under thecurve(AUC)was 0.803,0.749 and 0.761,respectively.The AUC of combined prediction of postoperative recurrence and metastasis ofthe three indexes was 0.915,and the sensitivity and specificity were 0.94 and 0.83,respectively.Conclusion:Tumor diameter,invasivenon-specific carcinoma,TNM stage,vascular tumor thrombus,number of axillary lymph node metastases,and abnormal elevation of pre-operative serum CA125,COX-2,sTNFR-P55 are risk factors for recurrence and metastasis within 5 years after modified radical mastec-tomy.Combined detection of preoperative serum CA125,COX-2 and STNFR-P55 can predict the risk of recurrence and meta