FIGO 分期 IV 期上皮性卵巢癌患者中预处理血小板计数和 CA125 水平（PLT-CA125）联合评分的预后分层。
Combined score of pretreatment platelet count and CA125 level (PLT-CA125) stratified prognosis in patients with FIGO stage IV epithelial ovarian cancer.
机构信息
Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
出版信息
J Ovarian Res. 2019 Jul 31;12(1):72. doi: 10.1186/s13048-019-0544-y.
BACKGROUND
The majority of death-related ovarian cancer is epithelial ovarian cancer (EOC). Regarding the Federation of Gynecology and Obstetrics (FIGO) stage IV EOC, the 5-year overall survival (OS) has not changed in last decades. Platelet (PLT) count and CA125 level are both prognostic markers that related to inflammation and immune evasion in EOC. This study intended to assess the prognostic value of pretreatment PLT count and CA125 level in FIGO stage IV EOC.
METHODS
The study included 108 patients diagnosed with FIGO stage IV EOC and treated with surgery and/or chemotherapy between January 1995 and December 2016. The PLT counts and CA125 levels of the patients before any treatment were analysed with clinical and pathological parameters, OS and progression-free survival (PFS). The survival of different groups was analyzed using the Kaplan-Meier method. The PLT-CA125 scores (0, 1, and 2) were defined basing on the presence of thrombocytosis (PLT count > 400,000/μL), an elevated CA125 level (CA125 > 1200 U/mL), or both. The prognostic value of PLT-CA125 was assessed with a Cox regression model.
RESULTS
Median OS, but not median PFS, was significantly decreased in patients with thrombocytosis or elevated CA125 levels when compared with the others (p = 0.011 & p = 0.004). The median OS was significantly decreased in patients with a PLT-CA125 score of 2 [37.8 months; 95% confidence interval (CI) 20.6-54.9] compared with patients with a PLT-CA125 score of 0 (70.0 moths, 95% CI 38.0-101.9, p < 0.001). The median PFS was also significantly decreased in patients with a PLT-CA125 score of 2 (19.6 months; 95% CI 13.0-26.3) compared with patients with a PLT-CA125 score of 0 (32.0 months; 95% CI 23.3-40.7, p = 0.011). Furthermore, multivariate analysis identified both PLT-CA125 scores of 2 and 1 as independent poor prognostic factors for OS (p = 0.004 & p < 0.001) and PFS (p = 0.033 & p = 0.017) compared with a PLT-CA125 score of 0.
CONCLUSIONS
The pretreatment PLT-CA125 score can be a reliable marker with high accessibility for stratifying prognosis in patients with FIGO stage IV EOC.
背景
大多数与死亡相关的卵巢癌是上皮性卵巢癌（EOC）。对于妇产科联合会（FIGO）分期 IV 期 EOC，其 5 年总生存率（OS）在过去几十年中并未改变。血小板（PLT）计数和 CA125 水平均是与 EOC 相关的炎症和免疫逃逸的预后标志物。本研究旨在评估 FIGO 分期 IV 期 EOC 患者治疗前 PLT 计数和 CA125 水平的预后价值。
方法
该研究纳入了 108 例在 1995 年 1 月至 2016 年 12 月期间接受手术和/或化疗治疗的 FIGO 分期 IV 期 EOC 患者。分析了患者治疗前的 PLT 计数和 CA125 水平与临床和病理参数、OS 和无进展生存期（PFS）之间的关系。使用 Kaplan-Meier 方法分析不同组的生存情况。根据血小板增多症（PLT 计数>400,000/μL）、CA125 水平升高（CA125>1200 U/mL）或两者存在的情况，定义 PLT-CA125 评分（0、1 和 2）。使用 Cox 回归模型评估 PLT-CA125 的预后价值。
结果
与其他患者相比，血小板增多症或 CA125 水平升高的患者的中位 OS 显著降低（p=0.011 和 p=0.004），但中位 PFS 无显著差异（p=0.114 和 p=0.193）。与 PLT-CA125 评分为 0 的患者相比，PLT-CA125 评分为 2 的患者中位 OS 显著降低[37.8 个月；95%置信区间（CI）20.6-54.9]（p<0.001）。与 PLT-CA125 评分为 0 的患者相比，PLT-CA125 评分为 2 的患者的中位 PFS 也显著降低（19.6 个月；95% CI 13.0-26.3）（p=0.011）。此外，多变量分析确定 PLT-CA125 评分 2 和 1 均为 OS（p=0.004 和 p<0.001）和 PFS（p=0.033 和 p=0.017）的独立不良预后因素，与 PLT-CA125 评分为 0 相比。
结论
治疗前的 PLT-CA125 评分可以作为一种可靠的标志物，具有较高的可及性，可用于分层 FIGO 分期 IV 期 EOC 患者的预后。
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