卵巢上皮細胞癌(Epithelial Ovarian Cancer)血清中Mesothelin: 一個新的篩選標記和預後因子

Abstract

目的：研究血清中mesothelin和臨床病理因子之間的關係，並且檢驗mesothelin 是否可成為檢測卵巢癌的生物標記和獨立的預後因子。 方法：本研究涵蓋24位正常者、20位有良性卵巢症狀的婦女、以及122位罹患卵巢上皮細胞癌者，記錄其臨床及病理項目。以酵素連結免疫吸附法(ELISA)檢測這些婦女其血清檢體於治療前的mesothelin和CA125，分析檢測之血清mesothelin和CA125結果與病人的臨床及病理數據是否呈現相關性。我們進一步比較和評估組織病理學項目、血清中meosthelin和CA125對病人預後的影響。 結果：卵巢癌病患於手術前的血清mesothelin值較高於良性卵巢病灶或正常者(OD450吸光值比分別為2.465、1.384 和 0.912)。在比較卵巢癌患者手術前的血清mesothelin方面，從卵巢癌第一期到第四期相較也呈顯著性增加。在122位卵巢癌病患中，其治療前血清mesothelin過量表現者(1.51 (1.02-2.24)和卵巢癌後期患者(1.61 (1.03-2.49)) (相對危險性(95%信賴區間))，皆顯示出明顯較差的整體存活率(Overall Survival)。此外在83位經適當的減積手術(debulking surgery)的卵巢癌病患(1.59 (1.02-2.48))以及79位卵巢癌後期病患(2.18 (1.09-4.38))當其治療前血清mesothelin過量表現者其整體存活率(OS) 也明顯較差。 結論：治療前的血清mesothelin可以被視為一個新的腫瘤標記，作為卵巢上皮細胞癌的鑑別診斷以及預測卵巢癌病患預後的因子。

Objective. To investigate the relationship between serum mesothelin and clinico-pathological factors, and to determine whether mesothelin is a biomarker for detection and an independent prognostic factor of ovarian cancer. Methods. Twenty-four normal populations, 20 women with benign ovarian lesion, or 122 patients with epithelial ovarian cancer were enrolled. Clinical and pathologic items were recorded. Pretreatment mesothelin and CA125 serum samples of these women were measured by an enzyme-linked immunosorbent assay. The results were correlated to clinical data. The histopathologic items and serum meosthelin, and CA125 influencing clinical outcome were evaluated comparatively. Results. The preoperative serum levels of mesothelin (OD450 ratio) (2.465 vs. 1.384 vs. 0.912) were higher in ovarian cancer patients than in those with benign ovarian lesions or normal populations. The preoperative serum levels of mesothelin also significantly increased from stage I to IV. Elevated mesothelin serum levels before therapy (1.51 (1.02-2.24), Relative risk (95%CI)) and advanced stages (1.61 (1.03-2.49)) showed significantly poorer overall survival (OS) for 122 cancer patients. Elevated mesothelin serum levels before therapy also revealed significantly poorer OS for 83 cancer patients with optimal debulking surgery (1.59 (1.02-2.48)) and for 79 advanced-staged cancer patients (2.18 (1.09-4.38)). Conclusions. Pretreatment mesothelin serum levels might be regarded a new tumor marker for the differential diagnosis of ovarian cancer and an additional prognostic factor in predicting the outcome of ovarian carcinoma patients.