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目的超声形态积分(sonographic morphologic score,SMS)在卵巢癌术前诊断中具有重要价值,报道较多;而SMS在卵巢癌术后的应用报道较少,作用不明。本研究运用接受器工作特性曲线(receiver operating characteristic curve,ROC)分析比较SMS和CA125及CA199诊断卵巢癌术后复发的价值。方法收集2013-01-01-2015-06-30南通市肿瘤医院经手术病理确诊为卵巢癌64例患者的术后临床资料。所有患者行超声检查,计算SMS,检测血清CA125和CA199;SMS范围0~10,由肿瘤体积积分和结构积分组成。复发诊断标准以临床检查、MRI及盆腔肿块穿刺获取的病理诊断等综合判断。绘制ROC曲线,确定最佳截断值。结果 64例患者中,临床诊断29例肿瘤复发,SMS平均(5.0±0.3)分。未见复发35例,其中21例盆腔未见占位,SMS均为0分;1例炎症肿块,SMS 3分;13例淋巴囊肿,SMS平均(2.0±0.4)分。SMS和CA125诊断卵巢癌复发的曲线下面积分别为0.848和0.883,差异无统计学意义,Z=0.24,P=0.66;SMS和CA199的曲线下面积分别为0.872和0.813,差异无统计学意义,Z=0.48,P=0.26。以5为截断值,SMS诊断肿瘤复发的敏感度、特异度、阳性预期值和阴性预期值分别为75.86%、91.43%、88.00%和82.05%。SMS与卵巢癌复发诊断存在相关性,χ~2=30.168 3,P<0.001。结论 SMS与CA125和CA199诊断卵巢癌术后复发的ROC曲线下面积差异无统计学意义,SMS在卵巢癌复发诊断中具有重要价值。
OBJECTIVE: Sonographic morphologic score (SMS) is of great value in the preoperative diagnosis of ovarian cancer, and has many reports. However, the application of SMS in postoperative ovarian cancer is less reported and its role is unknown. In this study, receiver operating characteristic curve (ROC) was used to analyze the value of SMS and CA125 and CA199 in the diagnosis of postoperative recurrence of ovarian cancer. Methods Totally 64 patients with ovarian cancer who were confirmed by surgery and pathology at Nantong Cancer Hospital from January 2013 to January 2015 were retrospectively analyzed. All patients underwent ultrasound examination, calculation of SMS, detection of serum CA125 and CA199; SMS ranged from 0 to 10, consisting of tumor volume integrals and structural integrals. Recurrence diagnostic criteria to clinical examination, MRI and pelvic mass obtained by pathological diagnosis of comprehensive judgment. Draw the ROC curve to determine the best cutoff value. Results Among the 64 patients, 29 cases were clinically diagnosed as tumor recurrence with an average SMS of 5.0 ± 0.3. There were no recurrences in 35 cases, of which 21 cases had no pelvic space, with 0 points for SMS; 1 case of inflammatory mass with 3 points of SMS; 13 cases of lymphatic cyst with SMS average of (2.0 ± 0.4) points. The area under the curve of SMS and CA125 in the diagnosis of ovarian cancer recurrence were 0.848 and 0.883, respectively, with no significant difference (Z = 0.24, P = 0.66). The area under the curve of SMS and CA199 was 0.872 and 0.813 respectively, Z = 0.48, P = 0.26. The sensitivity, specificity, positive predictive value and negative predictive value of SMS diagnosis of tumor recurrence with 5 as cutoff value were 75.86%, 91.43%, 88.00% and 82.05% respectively. There was a correlation between SMS and the diagnosis of ovarian cancer recurrence, χ ~ 2 = 30.1683, P <0.001. Conclusion There was no significant difference in the area under the ROC curve between SMS and CA125 and CA199 in the diagnosis of ovarian cancer recurrence. SMS was of great value in the diagnosis of ovarian cancer recurrence.