卵巢癌患者血清CA125、淀粉样蛋白A、人附睾蛋白4水平变化及意义

目的 探讨卵巢癌患者血清糖类抗原125(CA125)、淀粉样蛋白A、人附睾蛋白4水平变化及意义。方法 选取2018年5月至2019年8月本院收治的卵巢癌患者58例为卵巢癌组;同期健康志愿者40例为对照组。抽取两组空腹外周肘静脉血4ml,检测血清CA125、淀粉样蛋白A、人附睾蛋白4浓度;患者出院后随访3年,记录生存情况。结果 卵巢癌组患者血清CA125、淀粉样蛋白A、人附睾蛋白4水平明显高于对照组,差异均有统计学意义(均P<0.01)。血清淀粉样蛋白A、人附睾蛋白4水平在不同TNM分期、淋巴结转移的卵巢癌患者间比较差异均有统计学意义(均P<0.05);CA125水平在不同TNM分期、淋巴结转移的卵巢癌患者间比较差异均无统计学意义(均P>0.05);CA125、血清淀粉样蛋白A、人附睾蛋白4水平在不同年龄、体质量指数的卵巢癌患者间比较差异均无统计学意义(均P>0.05)。ROC曲线分析显示,血清CA125、淀粉样蛋白A、人附睾蛋白4单独和联合检测对卵巢癌患者预后均有较高的评估价值(均P<0.05);其中血清CA125、淀粉样蛋白A、人附睾蛋白4联合检测的预测...     

血清CA125、CA199、癌胚抗原在卵巢癌诊断中的应用价值

目的探讨血清癌抗原125(CA125)、癌抗原199(CA199)、癌胚抗原在卵巢癌诊断中的应用价值。方法选取2018年1月至2019年8月本院收治的卵巢癌96例(卵巢癌组)和卵巢良性病变患者96例(卵巢良性病变组),收集同期在本院体检的健康志愿者96例为对照组。全自动化学免疫发光仪及配套试剂盒检测各组外周血血清CA125、CA199、癌胚抗原水平。结果卵巢癌组患者血清CA125、CA199、癌胚抗原水平明显高于卵巢良性病变组和对照组,卵巢良性病变组明显高于对照组,差异均有统计学意义(均P<0.05)。卵巢癌组患者血清CA125、CA199、癌胚抗原阳性率均明显高于卵巢良性病变组,差异均有统计学意义(均P<0.01)。血清CA125、CA199、癌胚抗原联合检测的敏感度为93.75%、准确率为86.46%,明显高于各指标单独检测,差异均有统计学意义(均P<0.01)。结论血清CA125、CA199、癌胚抗原联合检测卵巢癌具有较高的敏感度和准确率;但特异性处于中等水平,需结合超声等其他检查手段进行鉴别诊断。     

血清肿瘤标志物CA125、CA199检测在早期卵巢癌诊断中的应用价值

目的探讨血清肿瘤标志物糖类抗原125(CA125)、糖类抗原199(CA199)检测在早期卵巢癌诊断中的应用价值。方法选取本院2017年5月至2018年11月收治的卵巢肿瘤患者126例,根据手术病理结果分为卵巢癌组74例和良性卵巢肿瘤组52例;选取同期于本院体检的50例健康者作为对照组。所有受试者均进行CA125、CA199水平测定,比较3组和不同分期卵巢癌患者CA125、CA199水平差异;以手术病理结果作为金标准,分析CA125、CA199单独检测及联合检测的诊断价值。结果 3组CA125和CA199水平比较差异均有统计学意义(均P0.05)。Ⅲ-Ⅳ期卵巢癌患者CA125和CA199水平高于Ⅰ-Ⅱ期患者,差异均有统计学意义(均P0.05)。CA125、CA199联合检测的准确度、灵敏度及特异度均高于单项检测,差异均有统计学意义(均P0.05)。结论血清肿瘤标志物CA125、CA199检测在卵巢癌早期诊断中具有较高的应用价值,值得推广。     

血清HE4和CA125在卵巢癌早期筛查中的临床价值

目的探讨血清HE4和CA125在卵巢癌早期筛查中的临床价值。方法选取2013年10月-2017年3月在该院确诊为卵巢癌的患者50例为卵巢癌组,选取同期在该院进行妇科检查时发现的卵巢良性疾病患者50例为良性组,妇科门诊健康体检50例为对照组。采用免疫化学发光法和酶联免疫吸附法检测所有研究对象血清HE4、CA125水平,分析其对卵巢癌早期诊断的价值。结果卵巢癌组血清HE4、CA125水平均高于良性组和对照组,良性组高于对照组,差异有统计学意义(P0.05);联合检测血清HE4、CA125水平对卵巢癌诊断的敏感性、特异性及诊断符合率均高于单一检测,差异有统计学意义(P0.05);Ⅲ-Ⅳ期患者血清HE4、CA125水平均高于Ⅰ-Ⅱ期,差异有统计学意义(P0.05)。结论 HE4、CA125在卵巢癌患者血清中呈高水平状态,联合检测其血清水平有利于卵巢癌的早期诊断,可为临床个性化防治提供科学依据。     

血清CA125、HE4及IL-6联合检测卵巢癌患者的意义分析

目的 探讨血清CA125、HE4及IL-6联合检测早期及晚期卵巢癌患者的临床价值。方法 分析2017年1-12月在医院接受诊断治疗的105例盆腔肿物患者的临床资料,根据患者术后病理检验结果分为癌症组(卵巢癌患者)62例和良性组(卵巢良性疾病患者)43例,另选取同期在本院接受健康体检的51例健康女性为对照组。比较3组女性的基线资料、血清CA125、HE4及IL-6水平,分析血清CA125、HE4及IL-6联合检测及单项检测在早期或晚期卵巢癌患者中的诊断价值。结果 3组女性的基线资料差异无统计学意义(P>0.05)。癌症组患者血清IL-6、CA125及HE4水平明显高于良性组和对照组,差异有统计学意义(P<0.05);早期癌症组患者血清IL-6、CA125及HE4水平明显低于晚期癌症组,差异有统计学意义(P<0.05)。血清IL-6、CA125及HE联合检测在早期及晚期卵巢癌患者中的诊断价值均较单项指标检测高(P<0.05)。结论 血清IL-6、CA125及HE4联合检测在卵巢癌患者中的诊断价值突出,值得推广。     

血清人类软骨糖蛋白39和糖类抗原125联合检测在上皮性卵巢癌诊断中的价值

目的探讨血清人类软骨糖蛋白39 (YKL-40)和糖类抗原125 (CA125)联合检测在上皮性卵巢癌诊断中的价值。方法选择盘锦市中心医院2015年1月-2017年6月上皮性卵巢癌患者80例作为卵巢癌组,健康体检女性80例作为对照组。采用ELISA法测定血清YKL-40和CA125水平。结果卵巢癌组患者血清YKL-40和CA125水平均高于对照组,差异均有统计学意义(均P0.05)。卵巢癌Ⅲ～Ⅳ期组血清YKL-40和CA125水平均高于Ⅰ～Ⅱ期组,差异均有统计学意义(均P0.05)。卵巢癌组血清YKL-40、CA125及YKL-40+CA125阳性率均高于对照组,差异均有统计学意义(均P 0.05)。血清YKL-40诊断卵巢癌的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为83.75%、95.00%、94.37%、85.39%及89.38%;血清CA125诊断卵巢癌的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为91.25%、93.75%、93.59%、91.46%及92.50%;血清YKL-40+CA125诊断卵巢癌的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为98.75%、87.50%、88.76%、98.59%及93.13%。结论上皮性卵巢癌患者血清YKL-40和CA125水平升高,两者联合检测可提高卵巢癌诊断的灵敏度和诊断符合率。     

血清HE4、CA125联合检测鉴别盆腔肿块患者卵巢癌的诊断价值

目的:探讨新肿瘤标记物血清人附睾分泌蛋白4(HE4)和CA125联合检测鉴别妇科盆腔肿块患者卵巢癌的诊断价值。方法:将诊断为妇科盆腔肿块拟行手术的108例患者和40例健康体检妇女采用酶联免疫吸附法(ELISA法)测定HE4含量、电化学发光法测定CA125含量。结果:卵巢癌组患者血清HE4、CA125水平明显高于盆腔良性肿块组患者(良性组)及健康妇女(对照组),差异有统计学意义(P<0.05),良性组血清HE4水平与健康妇女(对照组)比较差异无统计学意义(P>0.05),而同组血清CA125水平与对照组比较差异有统计学意义(P<0.05);良性组和对照组血清HE4的阳性率均为0,而良性组血清CA125为30.1%,良性组中HE4的阳性率与同组血清CA125阳性率比较差异有统计学意义(P<0.01);HE4+CA125联合检测卵巢癌的敏感度、特异度分别为91.4%、80.5%,与单一指标检测敏感度进行比较差异有统计学意义(P<0.05)。结论:HE4是一种较理想的卵巢癌肿瘤标志物,其血清水平对妇科盆腔肿块良恶性疾病的鉴别诊断具有一定的应用价值,与CA125联合检测可以提高盆腔肿块患者中卵巢癌的鉴别诊断价值。     

血清人附睾蛋白4、糖类抗原125及卵巢癌恶性风险模型指数在卵巢癌诊断中的应用

目的探讨血清人附睾蛋白4(HE4)、糖类抗原125(CA125)水平及卵巢癌恶性风险模型(ROMA)指数在卵巢癌诊断中的应用价值。方法选取在武汉市第五医院诊治的卵巢癌患者67例作为卵巢癌组,选取卵巢良性肿瘤患者59例作为卵巢良性肿瘤组,同时选取59例体检健康女性作为对照组,采用电化学发光法检测所有患者血清HE4、CA125水平,并计算出ROMA指数联合评估卵巢癌风险。结果卵巢癌组血清HE4、CA125水平及ROMA指数的中位数分别为88.05pmol/L、51.85U/ml及31.17%,均高于卵巢良性肿瘤组和健康对照组,差异具有统计学意义(P<0.01)。卵巢良性肿瘤组与健康对照组比较,血清HE4、CA125水平比较,差异有统计学意义(P<0.05),ROMA指数比较,差异无统计学意义(P>0.05)。ROMA指数的灵敏度、特异度均优于单一检测HE4或CA125。结论联合检测血清HE4、CA125并计算ROMA指数,有助于评估卵巢肿瘤患者的卵巢癌患病风险性,从而有利于卵巢癌的早发现、早治疗。     

血清肿瘤标志物联合检测在卵巢癌诊断中的应用价值

目的探究血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原125(CA125)]联合检测在卵巢癌诊断中的应用价值。方法选择2017年6月至2019年5月医院收治的卵巢癌患者83例作为试验组,选择同期医院收治的卵巢良性疾病患者80例作为对照组,采集两组空腹静脉血,通过全自动免疫分析仪测定CEA、CA199、CA125水平,比较两组CEA、CA199、CA125水平及各指标单项、联合诊断的特异度、灵敏度。结果试验组CEA、CA199、CA125水平均高于对照组,差异有统计学意义(P<0.05);CEA+CA199+CA125诊断灵敏度高于各指标单项检测结果,差异有统计学意义(P<0.05)。结论血清肿瘤标志物联合检测有助于提高卵巢癌诊断灵敏度,利于早期诊断卵巢癌,并对治疗、转归进行评估。     

血清CA125联合HE4及卵巢恶性肿瘤风险算法指数在诊断绝经前后卵巢癌中的价值

目的探讨血清CA125联合HE4及卵巢恶性肿瘤风险算法(ROMA)指数在诊断绝经前后卵巢癌中的价值。方法选取2011年1月-2017年1月广州市花都区妇幼保健院收治的80例卵巢囊肿患者(卵巢囊肿组)和80例卵巢癌患者(卵巢癌组)为研究对象,另选取同期在该院接受体检的80例健康妇女为健康对照组,分析比较3组研究对象的血清CA125和HE4水平,计算3组入选人员的ROMA指数并进行相应的统计学分析。结果卵巢癌组患者的血清CA125、HE4水平和ROMA指数均显著高于卵巢囊肿组患者和健康对照组,差异均有统计学意义(均P<0.05)。绝经前ROMA(Pre-ROMA)指数在绝经前诊断卵巢癌效能中敏感度为100.00%,显著高于HE4和CA125,差异均有统计学意义(均P<0.05)。HE4的阳性预测值和特异度均为100.0%,均显著高于Pre-ROMA指数和CA125,差异均有统计学意义(均P<0.05)。Pre-ROMA指数的阴性预测值为100.0%,显著高于HE4,差异有统计学意义(P<0.05)。绝经前以健康对照组和卵巢囊肿组作为参照时,Pre-ROMA指数和HE4诊断卵巢癌的曲线下面积分别为0.569、0.568,差异均有统计学意义(均P<0.05)。绝经后以健康对照组和卵巢囊肿组作为参照时,CA125、绝经后ROMA(Post-ROMA)指数以及HE4的曲线下面积分别为0.642、0.664、0.681,差异均有统计学意义(均P<0.05)。结论血清CA125在绝经后卵巢癌患者中的诊断敏感度高于绝经前卵巢癌患者,而HE4则对绝经前后的卵巢癌患者均具有较高的诊断效能,其特异度显著优于CA125,两者联合检测并计算患者ROMA指数能够有效提升临床上对卵巢癌患者的诊断效能。     

Breast cancer, colorectal cancer, and esophageal cancer

This is the second of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charts the natural histories of breast, colorectal, and esophageal cancers. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and thus identify problems early in their development so that the problems are more easily managed.     

Cervical cancer in Bangladesh: community perceptions of cervical cancer and cervical cancer screening

We investigated the awareness of, and the attitude towards screening for, cervical cancer in Bangladesh. We performed a qualitative study using focus group discussions (FGD). The framework approach to qualitative analysis was used. The study was performed in the catchment areas of Addin Hospital, Jessore, Southern Bangladesh (peri-urban) and LAMB hospital, Parbatipur, North West Bangladesh (rural). A total of 220 men, women and adolescents participated in 28 FGDs. Awareness of cervical cancer was widespread. Knowledge about causes was often inadequate. The perceived consequences of cervical cancer were numerous and awareness of the need for cervical cancer treatment was present. Barriers to accessing care include: low priority for seeking help for symptoms, limited availability of health services and cost. Most women were unaware of the possibility of screening via speculum examination, which was considered acceptable to women (and men), as long as the examination was done by a female healthcare provider in an environment with sufficient privacy. In conclusion, adequate gynaecological services are not available or accessible for most women in rural and peri-urban Bangladesh. However, awareness of cervical cancer is widespread. Screening for cervical cancer in these communities is acceptable if done by a female healthcare provider under conditions with sufficient privacy.     

人源性宫颈癌、子宫内膜癌、卵巢癌异种移植动物模型的建立

目的构建人来源的宫颈癌(cervical cancer,CC)、子宫内膜癌(endometrial cancer,EC)、卵巢癌(ovarian cancer,OC)人源性肿瘤异种移植动物模型,为研究和开发新药及个体化治疗提供实验模型。方法收集2018年2月至2019年4月新疆医科大学第一附属医院CC、EC、OC患者各5例的新鲜手术切除标本,移植至重度免疫缺陷(immunodeficiency,NOG)小鼠和非肥胖糖尿病/重症联合免疫缺陷(non-obese diabetes/severe combined immunodeficiency,NOD/SCLD)小鼠皮下,监测荷瘤小鼠体重和肿瘤体积,对长至500~1 000 mm^3大小的肿瘤进行传代移植,通过苏木精-伊红染色法(hematoxylin-eosin staining,HE)染色及免疫组化(immunohistochemistry,IHC)验证移植肿瘤组织与患者肿瘤组织的病理学一致性。结果本研究收集并移植15例CC、EC、OC肿瘤标本,成功构建CC、EC、OC PDX模型8例,建模成功率为53%。结论模型较好地保留了原发肿瘤的特征,为后续研究开发CC、EC、OC新的治疗方案、临床药物筛选以及个体化治疗提供了实验平台。     

Estimation and projections of cancer prevalence from cancer registry data

A method, PIAMOD (Prevalence, Incidence, Analysis MODel), which allows the estimation and projection of cancer prevalence patterns by using cancer registry incidence and survival data is presented. As a first step the method involves the fit of incidence data by an age, period and cohort model to derive incidence projections. Prevalence is then estimated from modelled incidence and survival estimates. Cancer mortality is derived as a third step from modelled incidence, prevalence and survival. An application to female breast cancer is given for the Connecticut State by using data from the Connecticut Tumor Registry (CTR), 1973-1993. The age, period and cohort model fitted incidence quite well and allowed us to derive long-term projections up to 2030. Patients' survival was also projected to future years according to a scenario approach based on two extreme hypotheses: steady, that is, no more improvements after 1993 (conservative), and continuously improving at the same rate as during the observation period. Age-standardized estimated incidence shows a changing trend around the year 2005, when it starts decreasing. Age-standardized prevalence is expected to increase and change trend at a later date. Breast cancer mortality is projected as decreasing, as the combined result of no further increase in incidence and improving cancer patients' survival. An easy-to-use PIAMOD software package, on which work is in progress, will be made available to individual cancer registries and/or health planning institutions or authorities once it is developed. The use of the PIAMOD method for cancer registries will allow them to provide results of paramount importance for the whole community involved in the assessment of future disease burden scenarios in an evolving society.     

Evaluation of linked cancer registry and hospital records of breast cancer

Background: Information on the treatment of women with breast cancer in Australia is generally available only from special surveys. Analysis of routinely collected datasets may be more timely and cost effective, if the data are sufficiently accurate and complete.
Objective: To evaluate the accuracy and completeness of data on treatment in linked records of breast cancer from two routinely collected datasets.
Methods: The NSW Department of Health linked NSW Central Cancer Registry (CCR) records for 2,636 women diagnosed with breast cancer in NSW in 1992 to all hospital admission records in the NSW In-patient Statistics Collection (ISC) from January 1991 to June 1994. We queried the original paper records of subsets of women to identify missing or miscoded information and cases not notified to the CCR. We also compared the treatment data with data collected independently from the medical records of 19% of the women.
Results: ISC records linked to 89% of the CCR records. The CCR had identified 94.9% of women with breast cancer treated as hospital in-patients and 83% of these women had surgical treatment recorded in the ISC. The linked dataset under-estimated the percentage of women having breast-conserving therapy (-4%) and slightly over-estimated the percentage having mastectomy (+1%).We estimated that 42% of women treated surgically for breast cancer had actually had breast-conserving surgery, compared with 39% in the original dataset. There was no evident bias by age or by urban or rural residence in the under-recording of breast conservation. There was 94% agreement on the type of surgery between the linked dataset and the independent dataset.     

Nutrigenetics in cancer research--folate metabolism and colorectal cancer

The B vitamin folate is essential for one-carbon transfer reactions, including those related to the methylation of DNA or other substrates and nucleotide synthesis. Epidemiologic and experimental studies implicate low-folate intakes in elevated risk of colorectal neoplasia and suggest that biologic mechanisms underlying this relation include disturbances in DNA methylation patterns or adverse effects on DNA synthesis and repair. With the completion of the Human Genome Project, a vast amount of data on inherited genetic variability has become available. This genetic information can be used in studies of molecular epidemiology to provide information on multiple aspects of folate metabolism. First, studies linking polymorphisms in folate metabolism to an altered risk of cancer provide evidence for a causal link between this pathway and colorectal carcinogenesis. Second, studies on genetic characteristics can help clarify whether certain individuals may benefit from higher or lower intakes of folate or nutrients relevant to folate metabolism. Third, studies on genetic polymorphisms can generate hypotheses regarding possible biologic mechanisms that connect this pathway to carcinogenesis. Last, genetic variability in folate metabolism may predict survival after a cancer diagnosis, possibly via pharmacogenetic effects. To solve the puzzle of the folate-cancer relation, a transdisciplinary approach is needed that integrates knowledge from epidemiology, clinical studies, experimental nutrition, and mathematical modeling. This review illustrates knowledge that can be gained from molecular epidemiology in the context of nutrigenetics, and the questions that this approach can answer or raise.     

Phytochemicals and cancer

Epidemiological studies showing a protective effect of diets rich in fruits and vegetables against cancer have focused attention on the possibility that biologically-active plant secondary metabolites exert anti-carcinogenic activity. This huge group of compounds, now collectively termed 'phytochemicals', provides much of the flavour and colour of edible plants and the beverages derived from them. Many of these compounds also exert anti-carcinogenic effects in animal models of cancer, and much progress has been made in defining their many biological activities at the molecular level. Such mechanisms include the detoxification and enhanced excretion of carcinogens, the suppression of inflammatory processes such as cyclooxygenase-2 expression, inhibition of mitosis and the induction of apoptosis at various stages in the progression and promotion of cancer. However, much of the research on phytochemicals has been conducted in vitro, with little regard to the bioavailability and metabolism of the compounds studied. Many phytochemicals present in plant foods are poorly absorbed by human subjects, and this fraction usually undergoes metabolism and rapid excretion. Some compounds that do exert anti-carcinogenic effects at realistic doses may contribute to the putative benefits of plant foods such as berries, brassica vegetables and tea, but further research with human subjects is required to fully confirm and quantify such benefits. Chemoprevention using pharmacological doses of isolated compounds, or the development of 'customised' vegetables, may prove valuable but such strategies require a full risk-benefit analysis based on a thorough understanding of the long-term biological effects of what are often surprisingly active compounds.