铁死亡基因风险评分和PET代谢参数对晚期非小细胞肺癌预后的影响  

Influence of ferroptosis gene risk score and positron emission tomography metabolic parameters on the prognosis of advanced non-small cell lung cancer

作　　者：陈婧姼 杨俊泉[1] 高伊函 Jingjie Chen;Junquan Yang;Yihan Gao(Department of Radiotherapy,Tangshan People's Hospital(Tangshan Cancer Hospital),Tangshan 063000,China)

机构地区：[1]唐山市人民医院(唐山市肿瘤医院)放化一科,河北省唐山市063000

出　　处：《中国肿瘤临床》2023年第20期1053-1058,共6页Chinese Journal of Clinical Oncology

基　　金：河北省医学科学研究课题计划(编号:20192395)资助。

摘　　要：目的:探讨联合循环肿瘤细胞(circulating tumor cells,CTCs)铁死亡相关基因构建的风险评分与正电子发射计算机断层显像/电子计算机X射线断层扫描技术(positron emission tomography/computed tomography,PET/CT)评估的肿瘤代谢负荷结合用于晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)预后分层的临床意义。方法:选择2019年1月至2022年1月就诊于唐山市人民医院(唐山市肿瘤医院)的101例Ⅲ~Ⅳ期NSCLC患者,通过PET/CT定量评估代谢肿瘤体积(metabolic tumor volume,MTV)和糖酵解的总病变(total lesion glycolysis,TLG),分离患者外周血中CTCs并通过聚合酶链式反应(PCR)检测铁死亡相关基因(ALOX5、TFRC、PHKG2、FADS2、NOX1)表达,构建风险评分。结果:根据风险评分中位数,将患者分为风险评分低组(评分≤0.70,n=51)和风险评分高组(评分>0.70,n=50)。与风险评分低的患者相比,风险评分高的患者表现出明显更高的MTV和TLG水平(P<0.05)。风险评分和MTV、TLG之间存在显著的正相关(r=0.618、0.462,均P<0.001)。低MTV和低风险评分的患者的中位无进展生存期(progression-free survival,PFS)和中位总生存期(overall survival,OS)高于低MTV和高风险评分的患者(P<0.001)。低TLG和低风险评分患者的中位PFS和中位OS高于低TLG和高风险评分的患者(P<0.001)。多变量Cox回归分析显示,与低风险评分组相比,高风险评分组OS的风险比(HR)显著增加(HR=3.22,P=0.001)。在多变量分析中调整MTV和TLG后,NSCLC患者中高风险评分的HR相似(P<0.01)。结论:低风险评分和低MTV或低TLG显示出比低风险评分和高MTV或高TLG更好的预后。Objective:To assess the clinical significance of combining the risk score model based on ferroptosis-related genes from circulating tumor cells(CTCs)with tumor metabolic load using positron emission tomography/computed tomography(PET/CT)for prognostic stratification of advanced non-small cell lung cancer(NSCLC).Methods:From January 2019 to January 2022,101 patients with stageⅢ–ⅣNSCLC at Tangshan People's Hospital(Tangshan Cancer Hospital)were selected for research.The metabolic tumor volume(MTV)and total glycolytic lesion(TLG)were quantitatively evaluated using PET/CT.CTCs isolated from the peripheral blood of the patients,and the expression of ferroptosis-related genes(ALOX5,TFRC,PHKG2,FADS2,and NOX1)detected using polymerase chain reaction(PCR)were used to construct the risk score.Results:Based on the median risk score,patients were assigned into the low-risk score group(≤0.70,n=51)and the high-risk score group(>0.70,n=50).Compared with patients with low-risk scores,patients with high-risk scores showed significantly higher MTV and TLG values(P<0.05).A significant positive correlation existed between risk score and MTV and TLG values(r=0.618,0.462,both P<0.001).The median progression-free survival(PFS)and overall survival(OS)of patients with low MTV and low-risk scores were higher than those with low MTV and high-risk scores(P<0.001).The median PFS and OS of patients with low TLG and low-risk scores were higher than those with low TLG and high-risk scores(P<0.001).Multivariate Cox regression analysis showed that the hazard ratio(HR)of OS was significantly higher in the high-risk score group than in the low-risk score group(HR=3.22,P=0.001).After adjusting for MTV and TLG in multivariate analysis,the HR of high-risk scores was similar in patients with NSCLC(P<0.01).Conclusions:A low-risk score with low MTV or TLG shows a better prognosis than a low-risk score with high MTV or TLG.

关 键 词：正电子发射计算机断层显像/电子计算机X射线断层扫描技术 铁死亡途径 非小细胞肺癌 循环肿瘤细胞 预后 

分 类 号：R734.2[医药卫生—肿瘤]