Прогностическая значимость уровня противовирусных антител в развитии рецидива рака мочевого пузыря

Abstract

Serological diagnosis of virus-associated tumors attracts the attention of many specialists. The changes in the level of antiviral antibodies in tumors of different localizations are proved. In some cases, the authors suggest using these data either for screening of tumors or for controlling the cure. to evaluate the predictive value of antiviral antibodies for the recurrence of bladder cancer. a level of antiviral antibodies (IgG, M) against Epstein-Barr virus (EBV), herpes simplex virus (HSV) 1 and 2 types, cytomegalovirus (CMV) of 100 patients with bladder cancer (72 men and 28 women) aged from 38 to 90 years (mean age 65+/-10) was studied. Multivariate analysis with a construction of classification tree was performed. The recurrence of the bladder cancer was used as the dependent variable. in patients with recurrence of bladder cancer there was an increase in the level of anti-CMV IgG (616.5+/-501.46 U/ml vs. 339.06+/-306.61 U/ml, p=0.0017) and anti-EBV IgG-EBNA (246,7+/-207 U/ml vs. 141,5+/-163,7 U/ml, p=0.0118). After the construction of the classification tree, anti-CMV IgG, anti-EBV IgG-EBNA, tumor stage and the presence of CMV DNA in tumor tissue were selected. It allowed to classify correctly 20 of 24 patients with recurrence and 58 of 72 patients without relapse. The most significant predictors included anti-CMV IgG level (100%), anti-BNA IgG level (78%) and tumor stage (50%). The sensitivity, specificity, positive prognostic value (probability of tumor detection in patients with a positive test result), negative prognostic value (probability of absence of the tumor in persons with a negative test result) and accuracy were 83.33%, 80.56%, 58.82%, 93.55% and 81.25%, respectively. A multivariate analysis (binary logistic regression) was performed and a reliable model (2=22,438, p=0,00043) was created, including the following parameters: anti-CMV IgG more than 670 u/ml, anti-BNA IgG more than 130 u/ml, the degree of anaplasia, the presence CMV and/or EBV DNA in tumor tissue. Based on the regression equation, an accuracy test for prediction of tumor recurrence was carried out, which resulted in fairly high predictive results: specificity and sensitivity were 95.2% and 33.3%, respectively. anti-CMV IgG level more than 670 U/ml and anti-BNA IgG level more than 130 U/ml are reliable predictors for the recurrence of bladder cancer.