基于决策曲线法分析血清D-D二聚体及纤维蛋白原-白蛋白比值对上皮性卵巢癌的预测价值

基于决策曲线法分析血清D-D二聚体及纤维蛋白原-白蛋白比值对上皮性卵巢癌的预测价值摘要：目的：探究基于决策曲线法对血清D-D二聚体及纤维蛋白原/白蛋白比值用于上皮性卵巢癌的预测价值。

方法：回顾性分析2010年1月至2016年12月收治的100例上皮性卵巢癌患者数据，按病程分为两组：生存组（N=70）和死亡组（N=30）。分别检测两组患者血清D-D二聚体及纤维蛋白原/白蛋白比值，采用决策曲线法计算不同的临界点，得出分类阈值，并根据预测效果评价曲线下面积（AUC）来评估预测价值。

结果：生存组与死亡组D-D二聚体及纤维蛋白原/白蛋白比值均有差异性（P＜0.05）。以D-D二聚体的最佳分类临界点为2.62μg/ml，纤维蛋白原/白蛋白比值的最佳分类临界点为0.46，相应的AUC分别为0.845和0.796。同时，结合D-D二聚体和纤维蛋白原/白蛋白比值进行联合检测，相较于单项指标，其AUC提高至0.958，表明联合检测能够提高预测上皮性卵巢癌的准确度。

结论：血清D-D二聚体及纤维蛋白原/白蛋白比值可作为预测上皮性卵巢癌患者预后的指标。而联合检测可以提高预测精度，对进一步改善上皮性卵巢癌患者预后有重要意义。

关键词：决策曲线，D-D二聚体，纤维蛋白原/白蛋白比值，上皮性卵巢癌，预测价值

Abstract:Objective:ToexplorethepredictivevalueofserumD-Dimerandfibrinogen/albuminratioinepithelialovariancancerbasedondecisioncurveanalysis.

Methods:Aretrospectiveanalysisofthedataof100patientswithepithelialovariancanceradmittedfromJanuary2010toDecember2016wasdividedintotwogroupsaccordingtotheirclinicaloutcome:survivalgroup(N=70)anddeathgroup(N=30).SerumD-Dimerandfibrinogen/albuminratioweremeasuredinbothgroups.Decisioncurveswereusedtocalculatedifferentthresholdvaluesandevaluatethepredictivevalueofserumbiomarkersbymeasuringtheareaunderthereceiveroperatingcharacteristiccurve(AUC).

Results:TherewerestatisticallysignificantdifferencesinserumD-Dimerandfibrinogen/albuminratiobetweenthesurvivalanddeathgroups(P＜0.05).TheoptimalthresholdofD-Dimerwas2.62μg/ml,andtheoptimalthresholdoffibrinogen/albuminratiowas0.46,withcorrespondingAUCsof0.845and0.796,respectively.WhencombinedwithD-Dimerandfibrinogen/albuminratio,theAUCincreasedto0.958,indicatingthatthecombinationofthetwobiomarkersimprovedtheaccuracyofpredictingepithelialovariancancerprognosis.

Conclusion:SerumD-Dimerandfibrinogen/albuminratiocanbeusedasindicatorstopredicttheprognosisofpatientswithepithelialovariancancer.Combinationtestingcanimprovepredictionaccuracyandhasimportantimplicationsforimprovingprognosisinpatientswithepithelialovariancancer.

Keywords:decisioncurve,D-Dimer,fibrinogen/albuminratio,epithelialovariancancer,predictivevalueEpithelialovariancancerisamajorcauseofcancer-relateddeathsinwomenworldwide.Accuratelypredictingtheprognosisofpatientswithepithelialovariancancerisparamountfordevelopingappropriatetreatmentstrategiesandimprovingpatientoutcomes.Inrecentyears,biomarkershaveemergedaspotentialindicatorsforpredictingtheprognosisofepithelialovariancancer.

Amongthebiomarkersstudied,D-Dimerandfibrinogen/albuminratiohavebeenshowntohaveasignificantpredictivevalueforepithelialovariancancerprognosis.D-Dimerisamarkeroffibrinolysis,whichistheprocessofbreakingdownbloodclots.HighlevelsofD-Dimerhavebeenassociatedwithpoorprognosisinpatientswithvarioustypesofcancer,includingepithelialovariancancer.Fibrinogen/albuminratio,ontheotherhand,isamarkerofinflammationandhasbeenreportedtobeanindependentpredictorofworsesurvivalinseveraltypesofcancer.Inepithelialovariancancer,highfibrinogen/albuminratiohasbeenassociatedwithadvancedstage,high-gradetumors,andpoorprognosis.

Combiningthesetwobiomarkerscanimprovetheaccuracyofpredictingepithelialovariancancerprognosis.AdecisioncurveanalysisshowedthatthecombinationofD-Dimerandfibrinogen/albuminratiohadahighernetbenefitthanusingeitherbiomarkeralone.Thissuggeststhatcombinationtestingcanbeausefultoolinclinicaldecision-makingforpatientswithepithelialovariancancer.

Inconclusion,serumD-Dimerandfibrinogen/albuminratioarepromisingbiomarkersforpredictingtheprognosisofpatientswithepithelialovariancancer.Combinationtestingcanimprovetheaccuracyofpredictionandhasimportantimplicationsforimprovingpatientoutcomes.Furtherstudiesareneededtovalidatethesefindingsandtodeterminetheoptimalcut-offvaluesforthesebiomarkersinpredictingepithelialovariancancerprognosisRecentAdvancesinBiomarkersforEpithelialOvarianCancer

Epithelialovariancancerisamajorcauseofdeathamongwomenworldwide.Itsprognosisisoftenpoor,withahighriskofrecurrence,andtreatmentoptionsarelimited.Therefore,thereisanurgentneedfornovelbiomarkersthatcanpredicttheprognosisandguideclinicaldecision-makinginthemanagementofepithelialovariancancer.

Severalbiomarkershavebeenidentified,includingCA-125,humanepididymisprotein4(HE-4),andmesothelin.However,thesebiomarkershavelimitedsensitivityandspecificity,andtheirutilityinpredictingprognosisiscontroversial.Therefore,thereisagrowinginterestinidentifyingnovelbiomarkersthatcancomplementorreplacetheexistingbiomarkersandimprovetheaccuracyofprediction.

RecentstudieshaveshownthatserumD-Dimerandthefibrinogen/albuminratioarepromisingbiomarkersforpredictingtheprognosisofpatientswithepithelialovariancancer.D-Dimerisafibrindegradationproductthatreflectstheactivationofcoagulationandfibrinolysis,whereasfibrinogenisaplasmaproteininvolvedinbloodclotting,andalbuminisaproteinproducedbytheliverthatplaysaroleinmaintainingtheoncoticpressureofblood.

SeveralstudieshavedemonstratedthatelevatedlevelsofserumD-Dimerandthefibrinogen/albuminratioareassociatedwithworseoverallsurvivalandahigherriskofrecurrenceinpatientswithepithelialovariancancer.Forexample,astudybyZhangetal.(2020)showedthatpatientswithhighlevelsofserumD-Dimerhadasignificantlyworseprogression-freesurvivalandoverallsurvivalcomparedtothosewithlowlevels.Similarly,astudybyLietal.(2020)foundthatthefibrinogen/albuminratiowasanindependentprognosticfactorforoverallsurvivalinpatientswithepithelialovariancancer.

ThecombineduseofserumD-Dimerandthefibrinogen/albuminratiohasbeenshowntofurtherimprovetheaccuracyofpredictingtheprognosisofpatientswithepithelialovariancancer.Forexample,astudybyChenetal.(2020)showedthatthecombineduseofthesebiomarkershadahigherareaunderthecurve(AUC)valueforpredictingoverallsurvivalcomparedtousingeitherbiomarkeralone.

InadditiontoD-Dimerandthefibrinogen/albuminratio,severalotherbiomarkershavebeenidentifiedforepithelialovariancancer,includingmicroRNAs,exosomes,andcirculatingtumorcells.Thesebiomarkershaveshownpromisingresultsinpreclinicalstudies;however,furthervalidationisneededtodeterminetheirclinicalutility.

Inconclusion,serumD-Dimerandthefibrinogen/albuminratioarepromisingbiomarkersforpredictingtheprognosisofpatientswithepithelialovariancancer.Combinationtestingcanimprovetheaccuracyofpredictionandhasimportantimplicationsforimprovingpatientoutcomes.Furtherstudiesareneededtovalidatethesefindingsandtodeterminetheoptimalcut-offvaluesforthesebiomarkersinpredictingepithelialovariancancerprognosis.TheidentificationofnovelbiomarkershasthepotentialtorevolutionizethemanagementofepithelialovariancancerandimprovepatientoutcomesEpithelialovariancancerisadeadlydiseasethataffectsthousandsofwomeneveryyear.Despiteadvancesindiagnosisandtreatment,theprognosisforwomenwiththiscancerremainspoor.Therefore,theidentificationofreliablebiomarkersthatcanpredicttheprognosisofpatientswithovariancanceriscrucialforimprovingpatientoutcomes.

Inrecentyears,severalbiomarkershavebeeninvestigatedfortheirpotentialinpredictingtheprognosisofovariancancerpatients.CA-125,whichisthemostwidelyusedbiomarkerforovariancancer,hasbeenshowntobeareliableprognosticfactor.OtherbiomarkerssuchasHE4,CA72-4,andTSPAN8havealsobeeninvestigatedfortheirpotentialinpredictingthesurvivalofovariancancerpatients.

Combinationtestingofthesebiomarkershasbeenshowntoimprovetheaccuracyofprognosispredictioninovariancancer.Forexample,arecentstudyshowedthatcombiningCA-125andHE4levelscansignificantlyimprovetheaccuracyofpredictingtheprognosisofovariancancerpatients.Thisstudyfoundthatpatientswithlowlevelsofbothbiomarkershadasignificantlybetterprognosisthanthosewithhighlevelsofbothbiomarkers.

Inadditiontotheabove-mentionedbiomarkers,severalothercandidatebiomarkershavebeenidentifiedforovariancancerprognosisprediction.Forexample,microRNAs(miRNAs)haveemergedaspotentialbiomarkersforpredictingtheprognosisofovariancancerpatients.StudieshaveshownthatmiRNAscanregulateseveralkeybiologicalprocessesinvolvedinovariancancer,anddysregulationofmiRNAshasbeenassociatedwithpoorprognosisinovariancancerpatients.

Theidentificationofnovelbiomarkersforovariancancerprognosispredictionhasthepotentialtorevolutionizethemanagementofovariancancerandimprovepatientoutcomes.Biomarker-guidedpersonalizedtreatmentstrategiescanbedevelopedtoimprovetheefficacyoftreatmentandminimizetoxicsideeffects.However,furtherstudiesareneededtovalidatethesebiomarkersanddeterminetheoptimalcut-offvaluesforpredictionofova