Study on relationship between serum gastrin-17 and platinum resistance recurrence after platinum chemotherapy in ovarian cancer
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摘要: 目的 探讨血清胃泌素-17(G-17)与卵巢癌铂类药物化疗后铂耐药复发的关系。方法 回顾性收集医院2017年1月至2023年6月收治的104例卵巢癌铂类药物化疗后复发的患者资料，根据复发类型分为铂耐药复发组(20例)与铂敏感复发组(84例)。比较2组患者临床资料及入院时血清G-17水平，重点分析血清G-17与卵巢癌铂类药物化疗后铂耐药复发的关系。结果 2组患者年龄、病理分级等一般资料比较，差异无统计学意义(P>0.05)；铂耐药复发组国际妇产科联盟(FIGO)分期Ⅲ~Ⅳ期患者占比、Fagotti评分、人附睾蛋白4(HE4)水平均高于铂敏感复发组(P < 0.05)；铂耐药复发组化疗前及化疗后血清G-17水平均高于铂敏感复发组(P < 0.05)；经多因素logistic回归分析显示，Fagotti评分、HE4、化疗前及化疗后血清G-17与卵巢癌铂类药物化疗后铂耐药复发有关(P < 0.05)；经限制性立方样条模型分析显示，化疗前血清G-17水平与卵巢癌铂类药物化疗后铂耐药复发的关联呈非线性曲线型剂量反应关系(P < 0.05)，当化疗前血清G-17>8.29 pmol/L时，患者铂耐药复发风险随指标水平升高而增加；以化疗前血清G-17水平为预测指标，绘制受试者工作特征曲线，结果显示，卵巢癌患者化疗前血清G-17预测卵巢癌铂类药物化疗后铂耐药复发的曲线下面积为0.755(95%CI 0.640~0.870)，灵敏度、特异度分别为70.0%、75.0%。结论 卵巢癌患者铂类药物化疗后铂耐药复发可能与化疗前血清G-17水平异常表达有关，血清G-17水平异常升高或提示患者铂耐药复发高风险，对铂耐药复发有一定预测价值。Abstract: Objective To explore the relationship between serum gastrin-17(G-17) and platinum resistance recurrence in ovarian cancer after platinum based chemotherapy.Methods A retrospective collection of data was conducted on 104 patients with recurrent ovarian cancer after platinum chemotherapy treated at Hospital from January 2017 to June 2023. According to the type of recurrence, they were divided into platinum resistant recurrence group(20 cases) and platinum sensitive recurrence group(84 cases). The clinical data and serum G-17 level at admission were compared between the two groups, and the relationship between serum G-17 and the recurrence of platinum-resistant ovarian cancer after platinum chemotherapy was analyzed.Results There was no statistical significant difference in general information such as age and pathological grade between the two groups(P>0.05). The proportion of International Federation of Gynecology and Obstetrics(FIGO) stage Ⅲ-Ⅳ patients, Fagotti score, and human epididymal protein 4(HE4) levels in the platinum resistant recurrence group were higher than those in the platinum sensitive recurrence group(P < 0.05). The serum G-17 levels in the platinum resistant recurrence group before and after chemotherapy were higher than those in the platinum sensitive recurrence group(P < 0.05). Multiple logistic regression analysis showed that Fagotti score, HE4, serum G-17 levels before and after chemotherapy were associated with platinum resistance recurrence in ovarian cancer after platinum based chemotherapy(P < 0.05). According to the Restricted Cubic Spline Model analysis, there was a non-linear dose-response relationship between pre chemotherapy serum G-17 levels and platinum resistance recurrence in ovarian cancer after platinum drug chemotherapy(P < 0.05). When pre chemotherapy serum G-17>8.29 pmol/L, the risk of platinum resistance recurrence in patients increased with the increase of indicator levels. Pre chemotherapy serum G-17 levels were used as a predictive indicator, a receiver operating characteristic curve was plotted. The results showed that the area under the curve of pre chemotherapy serum G-17 in ovarian cancer patients predicting platinum resistance recurrence after platinum chemotherapy was 0.755(95%CI 0.640-0.870), with sensitivity and specificity of 70.0% and 75.0%, respectively.Conclusion The recurrence of platinum resistance in ovarian cancer patients after platinum based chemotherapy may be related to abnormal expression of serum G-17 levels before chemotherapy. Abnormal elevation of serum G-17 levels may indicate a high risk of platinum resistance recurrence in patients, and have certain predictive value for platinum resistance recurrence.
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Key words:
- ovarian cancer /
- chemotherapy /
- platinum resistance /
- recurrence /
- serum gastrin-17
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表 1 不同复发类型患者临床资料比较
组别 铂耐药复发组(n=20) 铂敏感复发组(n=84) t/χ2 P 年龄/岁 57.65±4.85 56.86±5.00 0.639 0.525 既往史/例(%) 糖尿病 9(45.00) 32(38.10) 0.322 0.570 高血压 13(65.00) 51(60.71) 0.125 0.723 FIGO分期/例(%) 5.349 0.021 Ⅰ~Ⅱ期 9(45.00) 57(67.86) Ⅲ~Ⅳ期 11(55.00) 27(32.14) 病理类型/例(%) 3.499 0.167 浆液性卵巢癌 17(85.00) 80(95.24) 黏液性卵巢癌 2(10.00) 2(2.38) 透明细胞癌 1(5.00) 2(2.38) 病理分级/例(%) 1.162 0.281 高级别 14(70.00) 68(80.95) 低级别 6(30.00) 16(19.05) Fagotti评分/分 6.00(6.00，6.00) 4.00(4.00，6.00) 3.001 0.003 CA125/(U/mL) 470.39±186.12 462.48±179.05 0.176 0.860 CA199/(U/mL) 134.64±13.19 130.14±15.25 1.215 0.227 HE4/(pmol/L) 416.29±81.77 348.83±79.98 3.376 0.001 
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表 2 不同复发类型患者血清G-17比较
pmol/L，X±S 组别 例数 化疗前 化疗后 t P 铂耐药复发组 20 9.24±2.36 13.34±2.58 5.030 < 0.001 铂敏感复发组 84 7.01±2.28 11.85±3.01 10.489 < 0.001 t 3.912 2.025 P < 0.001 0.046
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表 3 变量赋值情况
变量 赋值 因变量 复发类型 铂耐药复发=1，铂敏感复发=0 化疗前血清G-17 实测值 化疗后血清G-17 实测值 自变量 FIGO分期 Ⅲ~Ⅳ期=1，Ⅰ~Ⅱ期=0 Fagotti评分 实测值 HE4 实测值
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表 4 卵巢癌铂类药物化疗后铂耐药复发与主要指标关系的回归分析
项目 B SE Wald P OR 95%CI FIGO分期 0.888 0.659 1.816 0.178 2.430 0.668~8.839 Fagotti评分 0.451 0.217 4.343 0.037 1.570 1.027~2.401 HE4 0.012 0.005 5.955 0.015 1.012 1.002~1.021 化疗前血清G-17 0.451 0.157 8.297 0.004 1.571 1.155~2.135 化疗后血清G-17 0.297 0.121 6.001 0.014 1.346 1.061~1.708 常量 -17.051 3.903 19.085 < 0.001 - -
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