Pre-treatment prediction of chemoresistance in second-line chemotherapy of ovarian carcinoma: value of serological tumor marker determination (tetranectin, YKL-40, CASA, CA 125)
Pre-treatment prediction of chemoresistance in second-line chemotherapy of ovarian carcinoma: value of serological tumor marker determination (tetranectin, YKL-40, CASA, CA 125)
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DOI：
10.1177/172460080602100302
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发表时间：
2006-07-01
影响因子：
2
通讯作者：
Hogdall, C.
中科院分区：
文献类型：
--
作者：
Gronlund, B.;Hogdall, E. V. S.;Hogdall, C.
目的：探讨复发期血清学肿瘤标志物水平的测定对卵巢癌患者二线化疗耐药的预测价值。方法：从连续的单机构上皮性卵巢癌患者中，我们选择了82例(a)实体瘤复发，(b)由拓扑替康（铂耐药疾病）或紫杉醇加卡铂（铂敏感疾病）组成的二线化疗患者。分析保存的血清样本中肿瘤生化标志物四联素、YKL-40、CASA（癌症相关血清抗原）和ca125。复发时血清肿瘤标志物水平与4个周期二线化疗后标志性时间的反应情况相关。进行单因素和多因素logistic回归分析（化疗耐药与非化疗耐药疾病）。结果：在里程碑时间，26%的患者根据GCIG（妇科癌症组间）进展标准进展。在单因素logistic回归分析中，肿瘤标志物tetranectin （OR 0.4; 95% CI: 0.2-0.8; p=0.008）、YKL-40 （OR 1.8; 95% CI: 1.0-3.3; p=0.045）和CASA （OR 1.8; 95% CI: 1.2-2.7; p=0.007）对二线化疗耐药具有预测价值，而血清CA 125没有预测价值。在多变量logistic回归分析中，血清四联素和CASA对化疗耐药均有独立的预测价值。联合检测tetranectin和CASA预测化疗耐药的特异性为90%，敏感性为33%（受试者工作特征曲线下面积= 0.78;95% CI: 0.66 ~ 0.91; p=0.001）。结论：低血清四联素水平，或高血清CASA或YKL-40水平与卵巢癌患者二线化疗耐药风险增加相关。
Objective: To examine if the determination of the levels of serological tumor markers at time of relapse had any predictive value for chemoresistance in the second-line treatment of ovarian cancer patients.Methods: From a registry of consecutive single-institution patients with epithelial ovarian carcinoma pretreated with paclitaxel plus platinum, we selected 82 patients with (a) solid tumor recurrence, and (b) second-line chemotherapy consisting of topotecan (platinum-resistant disease) or paclitaxel plus carboplatin (platinum-sensitive disease). Stored serum samples were analyzed for the biochemical tumor markers tetranectin, YKL-40, CASA (cancer-associated serum antigen), and CA 125. The serum tumor marker levels at time of relapse were correlated with response status at landmark time after 4 cycles of second-line chemotherapy. Univariate and multivariate logistic regression analyses (chemoresistant vs non-chemoresistant disease) were performed.Results: At landmark time, 26% of patients had progression according to the GCIG (Gynecologic Cancer Intergroup) progression criteria. In univariate logistic regression analysis, the tumor markers tetranectin (OR 0.4; 95% CI: 0.2-0.8; p=0.008), YKL-40 (OR 1.8; 95 % CI: 1.0-3.3; p=0.045), and CASA (OR 1.8; 95 % CI: 1.2-2.7; p=0.007) had predictive value for second-line chemoresistance, whereas serum CA 125 had no predictive value. In a multivariate logistic regression analysis, serum tetranectin and CASA both had independent predictive value for chemoresistance. The combined determination of tetranectin and CASA had a specificity of 90% with 33% sensitivity for the prediction of chemoresistance (area under the receiver operating characteristic curve = 0.78; 95% CI: 0.66-0.91; p=0.001).Conclusion: Low serum levels of tetranectin, or high serum levels of CASA or YKL-40, are associated with increased risk of second-line chemoresistance in patients with ovarian cancer.