乳腺癌改良根治术患者术后复发转移的危险因素及血清 CA125, COX-2, sTNFR-P55 的预测价值研究.

Objective: To study the risk factors of recurrence and metastasis in patients with breast cancer after modified radical mastectomy and the predictive value of serum carbohydrate antigen 125 (CA125), cyclo-oxygenase-2 (COX-2), soluble tumor necrosis factor receptor-P55 (sTNFR-P55). Methods: 109 patients with breast cancer who underwent modified radical mastectomy in The First Affiliated Hospital of Xinjiang Medical University from January 2014 to December 2016 were prospectively studied. All patients were followed up for 5 years after operation, including 2 patients who were lost to follow-up, and 107 patients who completed follow-up.According to the recurrence and metastasis within 5 years, the patients were divided into recurrence and metastasis group (n=31) and non-recurrence and metastasis group (n=76). The clinicopathological data of the patients at admission were collected. Preoperative serum CA125 was detected by electrochemiluminescence method, and preoperative serum COX-2 and sTNFR-P55 were detected by enzyme-linked immunosorbent assay. Logistic regression model was used to analyze the influencing factors of postoperative recurrence and metastasis, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of serum CA125, COX-2 and sTNFR-P55 on postoperative recurrence and metastasis. Results: The tumor diameter greater than 5cm, invasive non-specific carcinoma, vascular tumor thrombus, estrogen receptor (ER) /progesterone receptor (PR) negative, the constituent ratio of no endocrine therapy,TNM stage ⅢA, and the number of axillary lymph node metastases 4~9 in the recurrence and metastasis group were higher than those in the non-recurrence and metastasis group (P＜0.05). The levels of serum CA125, COX-2 and sTNFR-P55 in the recurrence and metastasis group were higher than those in the non-recurrence and metastasis group (P＜0.05). Multivariate logistic regression analysis showed that tumor diameter greater than 5cm, invasive non-specific carcinoma, TNM stage ⅢA, vascular tumor thrombus, number of axillary lymph node metastases 4~9, increased CA125, increased COX-2, and increased sTNFR-P55 were independent risk factors for recurrence and metastasis within 5 years after modified radical mastectomy (OR=1.318, 1.213, 1.223, 1.137, 1.257, 1.241, 1.313, 1.351, P＜0.05). Serum CA125, COX-2 and sTNFR-P55 could effectively predict postoperative recurrence and metastasis of breast cancer, and the area under the curve (AUC) was 0.803, 0.749 and 0.761, respectively. The AUC of combined prediction of postoperative recurrence and metastasis of the three indexes was 0.915, and the sensitivity and specificity were 0.94 and 0.83, respectively. Conclusion: Tumor diameter, invasive non-specific carcinoma, TNM stage, vascular tumor thrombus, number of axillary lymph node metastases, and abnormal elevation of preoperative serum CA125, COX-2, sTNFR-P55 are risk factors for recurrence and metastasis within 5 years after modified radical mastectomy. Combined detection of preoperative serum CA125, COX-2 and STNFR-P55 can predict the risk of recurrence and metastasis after modified radical mastectomy. [ABSTRACT FROM AUTHOR]