卵巢透明细胞癌血液学检验的临床意义

目的探讨卵巢透明细胞癌（OCCA）血液学检验结果的临床意义及其与预后的关系。方法回顾性分析1999年2月至2009年9月间我院收治的121例卵巢透明细胞癌患者的临床资料。结果中位发病年龄48岁（24～73岁）。FIGO分期：Ⅰ期57.0%（69/121）,Ⅱ期9.9%（12/121）,Ⅲ期30.6%（37/121）,Ⅳ期2.6%（3/121）。总的5年生存率（49.8%）：Ⅰ期68.7%,Ⅱ期76.4%,Ⅲ期13.9%,Ⅳ期0。初次治疗前、术后1周、化疗3程后及复发时CA125均值分别为（433.9±1051.3）U/ml、（162.9±327.0）U/ml、（20.3±40.5）U/ml和（317.0±1023.8）U/ml。初次治疗前CA125水平高于正常参考值者占87.2%（75/86）。初次治疗前CA19-9均值为（90.6±152.8）U/ml,高于正常参考值者占50.7%（34/67）;CEA均值为（3.6±9.4）ng/ml,高于正常参考值者占6.9%（2/29）;乳酸脱氢酶（LDH）均值（259.3±168.8）U/L,高于正常参考值者占35.9%（14/39）;血清钙均值（2.4±0.2）mmol/L,高于正常参考值者占9.8%（4/41）;血清铁均值（10.3±6.4）μmol/L,低于正常参考值者占35.1%（13/37）;血红蛋白（HGB）均值（123.7±17.4）g/L,低于正常参考值者占17.4%（4/23）。初次治疗前CA125水平≤1000U/ml组和〉1000U/ml组中位生存时间比较,差异有显著性（P=0.019）。化疗3程后CA125水平≤20U/ml组和〉20U/ml组中位生存时间比较,差异有显著性（P=0.002）。结论 OCCA血液学检验特点包括CA125及CA19-9升高、乳酸脱氢酶（LDH）升高、血钙升高、血清铁降低和血红蛋白（HGB）降低,初次治疗前和化疗3程后CA125水平可能与OC-CA的预后相关。

Clinical significance and prognostic analysis of serum chemical examination in the patients with ovarian clear cell adenocarcinoma

Objective To evaluate the clinical significance and prognostic analysis of serum chemical examination in the patients with ovarian clear cell adenocarcinoma（ OCCA） . Methods Medical records of 121 patients with OCCA treated in our hospital between February 1999 and September 2009 were analyzed retrospectively. Results： Median age at diagnosis was 48 years（ range 24-73 years） . Tumors were 57. 0% （ 69/121） stage Ⅰ,9. 9%（ 12/121） stage Ⅱ,30. 6%（ 37/121） stage Ⅲ,and 2. 6%（ 3/121） stage Ⅳ. 5-year overall survival rate was 49. 8% ,68. 7% in stage I,76. 4% in stage Ⅱ,13. 9% in stage Ⅲ,0 in stage Ⅳ,respectively. CA125 mean value was （ 433.9 ± 1051.3） U/ml（ pretherapy） ,（ 162.9 ± 327.0） U/ml （ postoperative） ,（ 20. 3 ± 40. 5） U/ml（ after 3-cycle chemotherapy） and （ 317. 0 ± 1023. 8） U/ml（ recurrence） ,respectively. 87. 2% CA125 values were higher than normal reference value before therapy. Before therapy,CA19-9 mean value was （ 90. 6 ± 152. 8） U/ml and 50. 7% were higher than normal reference val-ue; CEA was （ 3. 6 ± 9. 4） ng/ml and 6. 9% were higher than normal reference value; lactate dehydrogenase （ LDH） was （ 259. 3 ±168. 8） U/L and 35. 9% were higher than normal reference value; serum calcium was（ 2. 4 ±0. 2） mmol/L and 9. 8% were higher than normal reference value; serum iron was （ 10. 3 ± 6. 4） μmol/L and 35.1% were lower than normal reference value; hemoglobin（ HGB） was （ 123.7 ±17.4） g/L and 17. 4% were lower than normal reference value. The median survival time of patients showed significant difference between CA125≤1000 U/ml group and CA125 1000 U/ml group before therapy（ P = 0. 019） ; between CA125≤20 U/ml group and CA125 20 U/ml group after 3-cycle chemotherapy（ P = 0. 002） . Conclusion The characters of serum chemical examination in the patients with OCCA were high level of CA125,CA199,LDH and serum calcium; low level of serum iron and HGB. CA125 expressional levels before therapy or after 3-cycle chemotherapy were prognostic factors for OCCA.