Liu W L, Wang Z Z, Zhao J Z, Hou Y Y, Wu X X, Li W, Dong B, Tong T T, Guo Y J
Department of Molecular Pathology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Jan 25;52(1):26-31. doi: 10.3760/cma.j.issn.0529-567X.2017.01.007.
To investigate the mutations of BRCA genes in sporadic high grade serous ovarian cancer (HGSOC) and study its clinical significance. Sixty-eight patients between January 2015 and January 2016 from the Affiliated Cancer Hospital of Zhengzhou University were collected who were based on pathological diagnosis of ovarian cancer and had no reported family history, and all patients firstly hospitalized were untreated in other hospitals before. (1) The BRCA genes were detected by next-generation sequencing (NGS) method. (2) The serum tumor markers included carcinoembryonic antigen (CEA), CA(125), CA(199), and human epididymis protein 4 (HE4) were detected by the chemiluminescence methods, and their correlation was analyzed by Pearson linear correlation. Descriptive statistics and comparisons were performed using two-tailed -tests, Pearson's chi square test, Fisher's exact tests or logistic regression analysis as appropriate to research the clinicopathologic features associated with BRCA mutations, including age, International Federation of Gynecology and Obstetrics (FIGO) stage, platinum-based chemotherapy sensitivity, distant metastases, serum tumor markers (STM) . (1) Fifteen cases (22%, 15/68) BRCA mutations were identified (BRCA1: 11 cases; BRCA2: 4 cases), and four novel mutations were observed. (2) The levels of CEA, CA(199), and HE4 were lower in BRCA mutations compared to that in control group, while no significant differences were found (>0.05), but the level of CA(125) was much higher in BRCA mutation group than that in controls (=-3.536, =0.003). Further linear regression analysis found that there was a significant linear correlation between CA(125) and HE4 group (=0.494, <0.01), and the same correlation as CEA and CA(199) group (=0.897, <0.01). (3) Single factor analysis showed that no significant differences were observed in onset age, FIGO stage, distant metastasis, and STM between BRCA(+) and BRCA(-) group (>0.05), while significant differences were found in CA(125) and sensitivity to platinum-based chemotherapy between the patients with BRCA mutation and wild type (<0.05). The multiple factors analysis showed that the high level of CA(125) was a independent risk factor of BRCA mutations in sporadic HGSOC (=0.007). The combination of CA(125) with BRCA have great clinical significance, the mutation of BRCA gene could guild the clinical chemotherapy regiments.
探讨散发性高级别浆液性卵巢癌(HGSOC)中BRCA基因的突变情况并研究其临床意义。收集2015年1月至2016年1月郑州大学附属肿瘤医院的68例患者,这些患者基于卵巢癌病理诊断且无家族史报告,且所有首次住院患者此前未在其他医院接受过治疗。(1)采用二代测序(NGS)方法检测BRCA基因。(2)采用化学发光法检测血清肿瘤标志物,包括癌胚抗原(CEA)、CA125、CA199和人附睾蛋白4(HE4),并通过Pearson线性相关分析其相关性。根据研究与BRCA突变相关的临床病理特征(包括年龄、国际妇产科联盟(FIGO)分期、铂类化疗敏感性、远处转移、血清肿瘤标志物(STM))的需要,酌情使用双尾t检验、Pearson卡方检验、Fisher精确检验或逻辑回归分析进行描述性统计和比较。(1)共鉴定出15例(22%,15/68)BRCA突变(BRCA1:11例;BRCA2:4例),并观察到4个新突变。(2)与对照组相比,BRCA突变组CEA、CA199和HE4水平较低,差异无统计学意义(P>0.05),但BRCA突变组CA125水平显著高于对照组(t=-3.536,P=0.003)。进一步线性回归分析发现,CA125与HE4组之间存在显著线性相关(r=0.494,P<0.01),CEA与CA199组情况相同(r=0.897,P<0.01)。(3)单因素分析显示,BRCA(+)组和BRCA(-)组在发病年龄、FIGO分期、远处转移和STM方面差异无统计学意义(P>0.05),而BRCA突变患者与野生型患者在CA125和铂类化疗敏感性方面存在显著差异(P<0.05)。多因素分析显示,CA125高水平是散发性HGSOC中BRCA突变的独立危险因素(P=0.007)。CA125与BRCA联合具有重要临床意义,BRCA基因突变可指导临床化疗方案。