Analysis on related factors of lymph node metastasis and ovary involvement in endometrioid adenocarcinoma
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摘要:
目的 探讨子宫内膜样腺癌卵巢和腹盆腔淋巴结转移的相关危险因素。 方法 回顾性分析中国科学技术大学第一附属医院妇科2011年1月-2018年1月收治的经术后病理证实为子宫内膜样腺癌的189例患者的临床病理资料。 结果 单因素分析结果显示，子宫内膜样腺癌卵巢转移患者的D-二聚体、纤维蛋白原和CA125测量值均高于卵巢未转移者，且差异均有统计学意义（均有P < 0.05）。子宫内膜样腺癌腹盆腔淋巴结转移患者的体重指数测量值低于无淋巴转移者（t=2.133，P=0.040），但D-二聚体、纤维蛋白原、CA125的值均高于无淋巴转移的患者（均有P < 0.05）。多因素Logistic回归分析模型结果提示，D-二聚体升高（OR=1.448，95% CI：1.105~1.898）和纤维蛋白原升高（OR=1.925，95% CI：1.018~3.640）是子宫内膜样腺癌卵巢转移的危险因素；产次多是子宫内膜样腺癌腹盆腔淋巴转移的保护因素（OR=0.498，95% CI：0.253~0.982），而纤维蛋白原高表达是其危险因素（OR=2.191，95% CI：1.085~4.422）。 结论 纤维蛋白原和D-二聚体，特别是纤维蛋白原可以成为预测子宫内膜样腺癌是否转移卵巢或淋巴的血清学标记物。 Abstract:Objective To investigate the related factors of lymph node metastasis and ovary involvement in endometrioid adenocarcinoma. Methods The clinicopathological data of endometrioid adenocarcinoma patients who underwent surgical treatment at the first affiliated hospital of university of science and technology of China from January 2011 to January 2018 were analyzed retrospectively. A total of 189 endometrioid adenocarcinoma were retrieved in the study. Results In the univariate analysis, D-dimer, preoperative plasma fibrinogen and CA125 levels could be elevated in endometrioid adenocarcinoma patients with ovary involvement (all P < 0.05). Endometroid adenocarcinoma patients with lymph node metastasis had lower body mass index (BMI) (t=2.133, P=0.040), preoperative plasma fibrinogen, D-dimer, CA125 levels and BMI were higher in patients with lymph node metastasis (all P < 0.05). In Logistic regression analysis, D-dimer levels(OR=1.448, 95% CI: 1.105-1.898) and preoperative plasma fibrinogen(OR=1.925, 95% CI: 1.018-3.640) were elevated in endometrioid adenocarcinoma patients with ovary involvement; Multiparity was the protective factor(OR=0.498, 95% CI: 0.253-0.982) for endometrioid adenocarcinoma patients with lymph node metastasis, but elevated preoperative plasma fibrinogen (OR=2.191, 95% CI: 1.085-4.422) was the risk factor among the patients. Conclusion Increased preoperative plasma fibrinogen or D-dimer levels could be predictors of lymph node metastasis or ovary involvement in endometrioid adenocarcinoma. -
Key words:
- Endometrial endometrioid adenocarcinoma /
- Fibrinogen /
- D-dimer
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表 1 子宫内膜样腺癌卵巢转移相关因素的单因素分析[M(P25, P75)]
Table 1. Univariate analysis of the associated factors of ovary involvement in endometrioid adenocarcinoma [M(P25, P75)]
项目 卵巢转移组(n=16) 卵巢未转移组(n=173) t/Z值 P值 发病年龄(岁) 53.50(49.50, 64.50) 52.00(49.00, 58.00) -1.272 0.203 孕次(次) 2.00(1.25, 3.75) 3.00(2.00, 4.00) -1.014 0.310 产次(次) 1.00(1.00, 2.75) 2.00(1.00, 3.00) -1.888 0.059 BMI(kg/m2, x±s) 25.45±4.23 25.48±3.76 0.056 0.955 GLU(mmol/L) 5.30(4.95, 6.37) 5.15(4.74, 5.79) -1.187 0.235 ALT(IU/L) 15.00(11.00, 22.50) 18.00(13.00, 28.00) -1.932 0.053 AST(IU/L) 19.00(14.25, 26.00) 21.00(16.00, 26.50) -0.775 0.438 白蛋白(g/L, x±s) 41.31±4.17 42.42±3.34 1.249 0.213 D-二聚体(ug/ml) 0.89(0.21, 2.31) 0.23(0.13, 0.38) -2.776 0.005 纤维蛋白原(g/L) 3.04(2.41, 4.69) 2.64(2.23, 3.03) -2.090 0.037 CA125(U/mL) 51.34(19.76, 141.57) 21.05(14.63, 31.43) -2.938 0.003 Ki-67 0.30(0.21, 0.48) 0.40(0.20, 0.60) -0.419 0.675 
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表 2 子宫内膜样腺癌腹盆腔淋巴转移相关因素的单因素分析[M(P25, P75)]
Table 2. Univariate analysis of the associated factors of lymph node metastasis in endometrioid adenocarcinoma [M(P25, P75)]
项目 腹盆腔淋巴转移(n=18) 腹盆腔淋巴未转移(n=94) t/Z值 P值 发病年龄(岁，x±s) 54.94±6.46 53.82±9.05 -0.503 0.616 孕次(次) 3.00(2.00, 4.00) 3.00(2.00, 4.00) -0.423 0.673 产次(次) 1.00(1.00, 2.00) 2.00(1.00, 2.00) -1.780 0.075 BMI(kg/m2，x±s) 23.89±2.63 25.51±4.19 2.133 0.040 GLU(mmol/L) 5.17(4.43, 6.25) 5.245(4.86, 5.90) -0.832 0.405 ALT(IU/L) 17.50(11.75, 21.50) 17.5(12.00, 27.25) -0.718 0.473 AST(IU/L) 20.50(16.00, 28.75) 20.5(16.00, 26.00) -0.242 0.809 白蛋白(g/L，x±s) 41.08±3.30 42.56±3.85 1.522 0.131 D-二聚体(ug/ml) 0.39(0.24, 2.65) 0.23(0.10, 0.40) -2.702 0.007 纤维蛋白原(g/L，x±s) 3.29±0.96 2.81±0.80 -2.222 0.028 CA125(U/mL) 47.99(22.93, 58.17) 23.34(15.04, 37.15) -2.218 0.027 Ki-67 0.50(0.38, 0.70) 0.40(0.25, 0.60) -1.730 0.084
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表 3 子宫内膜样腺癌卵巢转移相关因素的多因素Logistic回归分析模型
Table 3. Multivariate Logistic regression analysis of main factors associated with ovary involvement in endometrioid adenocarcinoma
变量 β sx- Wald值 P值 OR(95% CI)值 发病年龄(岁) 0.072 0.040 3.217 0.073 1.075(0.993~1.162) 孕次(次) 0.037 0.239 0.024 0.876 1.038(0.650~1.657) 产次(次) -0.348 0.344 1.021 0.312 0.706(0.360~1.386) BMI(kg/m2) 0.034 0.080 0.176 0.675 1.034(0.884~1.209) CA-125(U/mL) 0.004 0.003 2.381 0.123 1.004(0.999~1.010) D-二聚体(ug/ml) 0.370 0.138 7.193 0.007 1.448(1.105~1.898) 纤维蛋白原(g/L) 0.655 0.325 4.062 0.044 1.925(1.018~3.640)
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表 4 子宫内膜样腺癌腹盆腔淋巴结转移相关危险因素的多因素Logistic回归分析
Table 4. Mutivariate Logistic regression analysis of related factors of lymph node metastasis in endometrioid adenocarcinoma
变量 β sx- Wald值 P值 OR(95% CI)值 发病年龄(岁) 0.051 0.039 1.679 0.195 1.052(0.974~1.137) 孕次(次) 0.172 0.185 0.859 0.354 1.187(0.826~1.706) 产次(次) -0.697 0.346 4.052 0.044 0.498(0.253~0.982) BMI(kg/m2) -0.138 0.081 2.901 0.089 0.871(0.744~1.021) CA125(U/mL) -0.001 0.002 0.464 0.496 0.999(0.994~1.003) D-二聚体(ug/ml) 0.251 0.146 2.964 0.085 1.285(0.966~1.709) 纤维蛋白原(g/L) 0.784 0.358 4.790 0.029 2.191(1.085~4.422)
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