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CA19-9、CA125和CP2在卵巢黏液性肿瘤诊断和监测中的价值

Clinical value of serum CA19-9,CA125 and CP2 in mucinous ovarian tumor:a retrospective study of 273 patients

摘要:

目的 探讨血清肿瘤标志物CA19-9、CA125及CP2在卵巢黏液性肿瘤诊断和监测中的价值.方法 对北京大学人民医院1999年1月至2007年6月间收治的273例卵巢肿瘤患者的临床资料进行回顾性分析,探讨血清肿瘤标志物CA19-9、CA125及CP2在50例卵巢黏液性肿瘤诊断和监测中的价值,并与223例卵巢非黏液性肿瘤进行比较.结果 (1)卵巢黏液性肿瘤中,CA19-9的曲线下面积最大(为0.95),其次是CA125(为0.90);而卵巢非黏液肿瘤中,CA125和CP2的曲线下面积最大(均为0.90).(2)卵巢黏液性肿瘤患者联合检测CA19-9和CA125时,其敏感度(93.8%)较单项检测(CA19-9和CA125分别为75.0%和66.7%)明显提高(P<0.05),而特异度(分别为86.1%、86.6%和90.2%)无明显变化(P>0.05).卵巢非黏液性肿瘤患者联合检测CA125和CP2时的敏感度(85.0%),较CP2(70.6%)单项检测明显提高,差异有统计学意义(P<0.05);较CA125(80.7%)单项检测虽有提高,但差异无统计学意义(P>0.05);3者的特异度(分别为90.2%、88.5%和93.9%)比较,差异无统计学意义(P>0.05).(3)82例卵巢恶性肿瘤术前血清肿瘤标志物阳性患者中,可行满意的肿瘤细胞减灭术患者[70%(57/82)]的血清肿瘤标志物于术后2个月内降为正常的百分率高于未能行满意肿瘤细胞减灭术者(分别为75%和28%),差异有统计学意义(P<0.05);且其术后血清肿瘤标志物再次上升的平均时间延长(分别为18.2和16.4个月),但差异无统计学意义(P>0.05);复发率(分别为35%和56%)及死亡率(分别为14%和32%)降低,差异有统计学意义(P<0.05).20例术前血清肿瘤标志物阴性患者均可行满意的肿瘤细胞减灭术,其中复发患者仅2例(10%).(4)卵巢黏液性肿瘤患者术后复发时多为血清CA19-9水平上升,而卵巢非黏液性肿瘤术后复发时主要为血清CA125水平上升,部分患者血清CP2水平也上升.(5)术前血清肿瘤标志物阳性患者较阴性患者生存率明显下降,其中CA125(+)与CA125(-)、CP2(+)与CP2(-)患者间生存率比较,差异有统计学意义(P<0.05);而CA19-9(+)与CA19-9(-)患者间生存率比较,差异则无统计学意义(P>0.05).结论 CA19-9是诊断卵巢黏液性肿瘤的敏感指标,与CA125联合检测可提高对卵巢黏液性肿瘤诊断的敏感度,并对术后监测有重要临床意义.CA125和CP2联合检测则对诊断卵巢非黏液肿瘤更敏感.

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abstracts:

Objective To evaluate the diagnostic and prognostic value of serum CA19-9,CA125 and CP2 in mucinous ovarian tumors.Methods In this retrospective study,the serum CA19-9,CA125 and CP2 levels of 273 hospitalized patients with ovarian tumors of either mucinous or non-mucinous type were analyzed.Results(1)CA19-9 had the biggest area under chive(AUC)in mucinous tumors followed with CA125 while CA125 and CP2 had bigger AUC in non-mucinous tumor.(2)For the diagnosis of mucinous tumors,CA19-9 and CA125 combination showed a greatly increased sensitivity compared with CA19-9 or CA125 alone(93.8%versus 75.0%and 66.7%,P<0.05)with no significant improvement of the specificity(P>0.05).For the diagnosis of non-mucinous tumors,CA125 and CP2 combination showed an increased sensitivity compared with CA125 or CP2 alone(85.0%versus 80.7%,P>0.05,85.0%versus 70.6%,P<0.05)with no significant improvement of the specificity(P>0.05).(3)Seventy percent of tumor marker-positive patients could undergo cytoreductive surgery.Compared with those who could not undergo cytoreductive surgery,they were more likely to have normal tumor marker two months after surgery (P<0.05)and longer interval to re-elevation of tumor markers(P>0.05),with lower reeurrence and death rate (P<0.05).All of the 20 tumor marker-negative patients could have eytoreduetive surgery with only 10%recurrence.(4)CA19-9 inereased mainly in recurrent mucinous tumor,while CA125 increased dominantly in recurrent non-mueinous tumor.(5)The survival rate of CA125 and CP2 positive patients was much lower than CA125 and CP2 negative patients(P<0.05),while the survival rate was similar between CA19-9 positive and CA19-9 negative patients.Conclusions CA19-9 is a sensitive index for diagnosis of mucinous ovarian tumors.Combination of CA19-9 with CA125 can improve the sensitivity of diagnosis and postoperative monitoring of mucinous ovarian tumors.Combination of CA125 with CP2 is more valuable in the diagnosis of non-mucinous ovarian tumors.

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