CTCs联合PLR对宫颈癌患者复发转移的预测价值  

Predictive value of CTCs combined with PLR for recurrence and metastasis of cervical cancer patients

作　　者：邱萍[1] 陈国英[1] 史淑兰[1] Qiu Ping;Chen Guoying;Shi Shulan(Department of Gynecology,Jingjiang People’s Hospital,Jingjiang 214500,Jiangsu,China)

机构地区：[1]靖江市人民医院妇科,江苏靖江214500

出　　处：《肿瘤代谢与营养电子杂志》2022年第4期474-480,共7页Electronic Journal of Metabolism and Nutrition of Cancer

摘　　要：目的探讨循环肿瘤细胞(CTCs)计数与宫颈癌患者临床病理特征及预后的关系,并进一步探索CTCs联合血小板-淋巴细胞计数比率(PLR)对宫颈癌患者复发转移的预测价值。方法选取2016年9月至2018年9月间于靖江市人民医院接受手术治疗的113例国际妇产科联盟(FIGO)ⅠB~ⅡA期宫颈癌患者为研究对象,识别并计数每例患者的外周血CTCs,分析其与肿瘤临床病理特征的关系。分别以CTCs、PLR及二者联合对所有宫颈癌患者进行重新分组,通过Kaplan-Meier曲线计算不同观察组患者的3年无疾病生存(DFS)率,Log-rank检验比较组间生存差异是否具有统计学意义。结果基于对CTCs阳性的定义,将所有患者分为CTCs≤1组与CTCs>1组,结果展示CTCs>1组与宫颈腺癌(χ^(2)=8.054,P=0.018)、子宫肌层浸润≥1/2(χ^(2)=5.512,P=0.019)、FIGO分期(ⅡA期:χ^(2)=4.484,P=0.034)、中性粒细胞-淋巴细胞计数比率(NLR)(≥2.20:χ^(2)=4.341,P=0.037)及PLR(≥130.4:χ^(2)=4.240,P=0.039)具有显著相关性。CTCs≤1与CTCs>1患者的3年DFS率分别为79.6%和40.4%,CTCs>1提示患者预后不佳(χ^(2)=18.938,P<0.001)。PLR<130.4与PLR≥130.4组的3年DFS率分别为81.6%和48.6%,PLR≥130.4与宫颈癌患者不良预后显著相关(χ^(2)=8.097,P=0.004)。此外,Kaplan-Meier曲线表明CTCs联合PLR进一步改善了ⅠB~ⅡA期宫颈癌患者的预后分层,CTCs≤1且PLR<130.4,CTCs>1或PLR≥130.4以及CTCs>1且PLR≥130.4三组患者的3年DFS率分别为89.4%,64.1%和16.8%,组间差异有统计学意义(89.4%比16.8%,χ^(2)=33.083,P<0.001;89.4%比64.1%,χ^(2)=5.779,P=0.016;64.1%比16.8%,χ^(2)=12.154,P<0.001)。单、多因素Cox生存分析证实CTCs联合PLR(HR=5.732,95%CI=1.966~16.713,P<0.001)和FIGO分期(HR=2.688,95%CI=1.272~5.680,P=0.010)是影响宫颈癌患者DFS的独立预测因子。结论外周血CTCs计数是宫颈癌患者一项有价值的预后指标,CTCs联合PLR或许有助于进一步识别高危个体,为宫颈癌患者的复发转移监测及个体�Objective This study aims to investigate the correlations between circulating tumor cells(CTCs)count and clinicopathologic characteristics and the prognosis of cervical cancer patients,and to further explore the predictive value of CTCs combined with platelet to lymphocyte ratio(PLR)for the recurrence and metastasis in cervical canc er patients.Method This analysis included 113 FIGO stageⅠB-ⅡA patients who underwent surgical resection for cervical cancer in our hospital from September 2016 to September 2018.The CTCs of each patient were identified and counted,and their correlations with the clinilopathological characteristics of cervical cancer patients was analyzed.All patients were reclassified into different research groups based on the CTCs,PLR and their combination.The 3-year disease-free survival(DFS)of cervical cancer patients in different groups was calculated by the KaplanMeier curves,and the log-rank test was used to compare the survival differences between various groups.Result On the basis of the definition of positive CTCs,all cervical cancer patients were divided into CTCs≤1 and CTCs>1 groups.The analytic results indicated that CTCs>1 were significantly associated with cervical adenocarcinoma(χ^(2)=8.054,P=0.018),myometrium invasion≥1/2(χ^(2)=5.512,P=0.019),FIGOⅡA stage(χ^(2)=4.484,P=0.034),high neutrophil-to-lymphocyte ratio(≥2.20:χ^(2)=4.341,P=0.037)and PLR(≥130.4:χ^(2)=4.240,P=0.039).The 3-year DFS of patients with CTCs≤1 and CTCs>1 were 79.6%and 40.4%respectively(χ^(2)=18.938,P<0.001).CTCs>1 suggested a poorer prognosis for cervical cancer patients.The 3-year DFS of patients with PLR<130.4 and PLR≥130.4 were 81.6%and 48.6%,respectively(χ^(2)=18.938,P<0.001).In addition,Kaplan-Meier curves showed that CTCs combined with PLR further improved the prognostic stratification for cervical cancer patients with FI GO IB-ⅡA stage.The 3-year DFS of patients with CTCs≤1 and PLR<130.4,CTCs>1 or PLR≥130.4 as well as CTCs>1 and PLR≥130.4 were 89.4%,64.1%and 16.8%,respectively.T

关 键 词：宫颈癌 循环肿瘤细胞 血小板-淋巴细胞计数比率 复发 预测 

分 类 号：R737.33[医药卫生—肿瘤]