基于外周血循环肿瘤细胞、循环肿瘤DNA构建列线图模型预测晚期宫颈癌患者的复发风险  

Prediction of advanced cervical cancer patients recurrence risk by a nematogram model based on peripheral blood circulating tumor cells and circulating tumor DNA

作　　者：谢孔英 祝佳 彭雯娟 吴海 XIE Kongying;ZHU Jia;PENG Wenjuan;WU Hai(Department of Gynecology,Leshan Maternal and Child Health Hospital,Leshan 614000,China)

机构地区：[1]乐山市妇幼保健院妇科,四川乐山614000

出　　处：《临床肿瘤学杂志》2025年第2期161-166,共6页Chinese Clinical Oncology

基　　金：乐山市重点科技计划项目(22SZD135)。

摘　　要：目的基于外周血循环肿瘤细胞(CTCs)、循环肿瘤DNA(ctDNA)构建列线图模型预测晚期宫颈癌患者的复发风险。方法选取2017年6月至2022年6月于乐山市妇幼保健院接受治疗的360例晚期宫颈癌患者。随访2年,根据患者的复发情况,将其分为复发组和未复发组,比较两组患者的临床资料,采用多因素Logistic回归模型分析影响晚期宫颈癌患者复发的风险因素。构建列线图模型,并采用校准曲线、Hosmer-Lemeshow检验及受试者工作特征(ROC)曲线验证该模型的效能。采用ROC曲线评估外周血CTCs、ctDNA预测晚期宫颈癌患者复发风险的价值。结果360例晚期宫颈癌患者中,有67例(18.61%)在随访2年内再次复发。复发组和未复发组在分化程度、肿瘤直径、盆腔淋巴结转移、脉管癌栓、间质浸润程度、CD4^(+)/CD8^(+)、D-二聚体(D-D)、CTCs、ctDNA方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,分化程度、肿瘤直径、盆腔淋巴结转移、CD4^(+)/CD8^(+)、CTCs、ctDNA均为晚期宫颈癌患者复发的独立影响因素(P<0.05)。列线图模型显示,CTCs是晚期宫颈癌患者复发风险的最强预测因子,其次是盆腔淋巴结转移、分化程度、ctDNA、CD4^(+)/CD8^(+)、肿瘤直径。校准曲线表明,晚期宫颈癌患者实际出现复发的情况与预测概率之间具有良好的预测准确度。Hosmer-Lemeshow检验显示,列线图模型预测值与真实值间的差异无统计学意义(P>0.05),表明该模型拟合较好,预测精准度较高。ROC曲线显示,列线图模型预测晚期宫颈癌患者复发风险的曲线下面积(AUC)为0.809(95%CI:0.758~0.860),灵敏度为0.861,特异度为0.742,约登指数为0.603,提示列线图模型为中度区分度,预测效能良好。ROC曲线显示,CTC、ctDNA预测复发风险的AUC分别为0.830、0.817,且联合检测高于单一检测,表明外周血CTC、ctDNA联合检测可作为预测晚期宫颈癌患者复发风险的有效指�Objective Based on peripheral blood circulating tumor cells(CTCs)and circulating tumor DNA(ctDNA),a nomogram model was constructed to predict the recurrence risk of advanced cervical cancer patients.Methods A total of 360 patients with advanced cervical cancer who received treatment in Leshan Maternal and Child Health Hospital,from June 2017 to June 2022 were selected.The patients were followed up for 2 years and divided into recurrence group and non-recurrence group according to the recurrence situation.The clinical data of the two groups were compared,and the risk factors leading to recurrence of advanced cervical cancer patients were analyzed by multivariate Logistic regression model.A nomogram model was constructed,and calibration curve,Hosmer-Lemeshow test and receiver operating characteristic(ROC)curve were used to verify the efficiency of the model.In addition,ROC curve was used to evaluate the value of peripheral blood CTCs and ctDNA in predicting the recurrence risk of advanced cervical cancer patients.Results Of 360 patients with advanced cervical cancer,67(18.61%)recurred within 2 years of follow-up.There were significant differences in differentiation degree,tumor diameter,pelvic lymph node metastasis,vascular cancer thrombe,interstitial infiltration degree,CD4^(+)/CD8^(+),D-D,CTCs and ctDNA between the recurrence group and the non-recurrence group(P<0.05).Multivariate Logistic regression analysis showed that differentiation degree,tumor diameter,pelvic lymph node metastasis,CD4^(+)/CD8^(+),CTCs and ctDNA were all independent factors leading to recurrence of advanced cervical cancer(P<0.05).The nomogram model showed that CTCs was the strongest predictor of recurrence risk in patients with advanced cervical cancer,followed by pelvic lymph node metastasis,degree of differentiation,ctDNA,CD4^(+)/CD8^(+),and tumor diameter.The calibration curve shows that there was a good prediction accuracy between the actual recurrence of advanced cervical cancer patients and the prediction probability.Hosmer-Lemeshow t

关 键 词：宫颈癌 循环肿瘤细胞 循环肿瘤DNA 列线图模型 复发 

分 类 号：R737.33[医药卫生—肿瘤]