不同转移路径对III期高级别浆液性卵巢癌预后的影响

Effect of Different Metastasis Pathways on Prognosis of Stage III High-Grade Serous Ovarian Cancer

摘要: 目的：分析不同转移路径对III期高级别浆液性卵巢癌预后的影响。方法：回顾性统计2000~2020年期间就诊于青岛大学附属医院符合纳入标准的III期高级别浆液性卵巢癌患者。根据转移路径，将患者分为单纯淋巴结转移组与腹膜转移组两组，采用卡方检验及Wilcoxon秩和检验分析患者临床特点、化疗敏感性、复发率等临床因素与患者不同转移路径之间的关系，应用Kaplan-Meier生存分析曲线及COX比例风险回归模型进行生存分析，讨论患者预后的影响因素。结果：按照纳入及排除标准，最终纳入FIGO III期高级别浆液性卵巢癌患者535例，统计分析结果显示，单纯淋巴结转移组初始CA125水平及初始HE4水平较腹膜转移组低，化疗敏感率更高，对化疗更敏感，复发率更低；生存分析提示不同转移路径间总生存率及无进展生存率均存在显著差异(P < 0.05)，腹膜转移组的中位生存时间及中位无进展生存时间均较单纯淋巴结转移组短，预后更差。初始HE4水平、化疗敏感性2个变量为影响III期HGSOC预后的独立因素，且与化疗耐药者相比化疗敏感者预后更好，与初始HE4水平较高者相比初始HE4水平较低者预后更好。结论：单纯淋巴结转移组较腹膜转移组化疗更敏感，复发率更低，生存时间更长，预后更好。初始HE4水平及化疗敏感性为影响III期HGSOC预后的独立因素，初始HE4水平较低者(<587.9 U/ml)预后更好。

Abstract: Objective: To analyze the effect of different metastasis paths on prognosis of stage III high-grade serous ovarian cancer. Methods: Patients with stage III high-grade serous ovarian cancer who visit-ed the Affiliated Hospital of Qingdao University from 2000 to 2020 and met the inclusion criteria were retrospectively analyzed. According to the metastasis path, patients were divided into two groups: simple lymph node metastasis group and peritoneal metastasis group. Chi-square test and Wilcoxon rank-sum test were used to analyze the relationship between clinical characteristics, chemotherapy sensitivity, recurrence rate and different metastatic paths of patients. Kaplan-Meier survival analysis curve and COX proportional risk regression model were used to perform survival analysis, and discuss the factors affecting prognosis of patients. Results: According to the inclusion and exclusion criteria, 535 patients with FIGO stage III high-grade serous ovarian cancer were fi-nally enrolled. Statistical analysis results showed that the initial CA125 level and initial HE4 level in the lymph node metastasis group were lower than those in the peritoneal metastasis group, and the sensitivity rate to chemotherapy was higher, and the sensitivity to chemotherapy was higher, and the recurrence rate was lower; survival analysis showed significant differences in overall survival, progression-free survival and 5-year progression-free survival (P < 0.05), the median survival time, median progression-free survival time and median 5-year progression-free survival time in the group with peritoneal metastasis were shorter than those in the group with only lymph node me-tastasis, indicating a worse prognosis. Conclusions: Simple lymph node metastasis was more sensi-tive to chemotherapy, with lower recurrence rate and longer survival time, which means better prognosis. Initial HE4 level and chemotherapy sensitivity were independent factors affecting the prognosis of stage III HGSOC, lower initial HE4 level (<587.9 U/mL) had better prognosis.