摘要
目的观察结直肠癌不同病理特征患者化疗前后循环肿瘤DNA(ctDNA)水平变化,并构建预后预测的列线图模型。方法选取2016年4月—2019年9月陕西省人民医院肿瘤外科收治的结直肠癌患者144例作为观察组,同期结直肠良性瘤患者72例作为对照Ⅰ组,健康体检者72例作为对照Ⅱ组。比较3组及观察组不同病理特征患者化疗前后ctDNA水平,随访2年统计观察组患者生存情况,Cox回归模型分析预后危险因素,并构建结直肠癌患者预后预测的列线图模型。结果ctDNA水平比较,观察组>对照Ⅰ组>对照Ⅱ组,差异均有统计学意义(F/P=229.968/<0.001);结直肠癌患者肿瘤直径>5 cm、分化程度低、浸润深度突破浆膜层、有淋巴结转移、T分期T4化疗前/后ctDNA水平均高于肿瘤直径≤5 cm、中—高分化、浸润深度未突破浆膜层、无淋巴结转移、T分期T1~3者(P<0.05);结直肠癌患者年龄≥50岁、肿瘤直径>5 cm、分化程度低、浸润深度突破浆膜层、有淋巴结转移、T分期T4、化疗前/后ctDNA水平≥142.58/86.59μg/L生存率低(χ^(2)/P=8.259/0.004,4.736/0.030,5.068/0.024,8.210/0.004,8.925/0.003,6.897/0.009,4.154/0.042,5.676/0.017);Cox回归模型分析显示,分化程度、淋巴结转移、T分期、化疗后ctDNA水平均是结直肠癌患者预后的独立影响因素[HR(95%CI)=0.512(0.334~0.786)、5.488(3.485~8.643)、5.843(4.079~8.371)、6.846(4.578~10.238)];以分化程度、淋巴结转移、T分期、化疗后ctDNA水平构建结直肠癌患者预后的列线图模型,一致性指数为0.892,校正曲线分析显示,预测模型预测病死风险与实际病死风险吻合度较高。结论结直肠癌患者ctDNA水平与病理特征有关;构建ctDNA水平、病理特征预测结直肠癌患者预后的列线图模型具有良好效能,便于指导临床积极完善治疗方案。
Objective To observe the changes of circulating tumor DNA(ctDNA)levels in colorectal cancer patients with different pathological characteristics before and after chemotherapy,and build a nomogram model for prognosis prediction.Methods A total of 144 colorectal cancer patients admitted to the Department of Oncology,Shaanxi Provincial People's Hospital from April 2016 to September 2019 were selected as the observation group,72 patients with benign colorectal tumors during the same period were selected as the control group I,and 72 healthy subjects were selected as the control group II..The ctDNA levels of patients with different pathological characteristics in the three groups and the observation group before and after chemotherapy were compared,and the survival of the patients in the observation group was followed up for 2 years.Cox regression model was used to analyze prognostic risk factors,and a nomogram model for predicting the prognosis of colorectal cancer patients was constructed.Results Comparison of ctDNA levels,observation group>control group I>control group II,the difference was statistically significant(F/P=229.968/<0.001).Colorectal cancer patients with tumor diameter>5 cm,low degree of differentiation,penetration depth beyond the serosal layer,lymph node metastasis,T stage T4 before/after chemotherapy,ctDNA levels were higher than tumor diameter≤5 cm,moderately well differentiated,and the depth of invasion did not break through Serous layer,no lymph node metastasis,T staging T1-3(P<0.05).Colorectal cancer patients aged≥50 years,tumor diameter>5 cm,low degree of differentiation,depth of invasion beyond the serosa,lymph node metastasis,T stage T4,ctDNA level before/after chemotherapy≥142.58/86.59μg/L,poor survival rate(χ^(2)/P=8.259/0.004,4.736/0.030,5.068/0.024,8.210/0.004,8.925/0.003,6.897/0.009,4.154/0.042,5.676/0.017).Cox regression model analysis showed that the degree of differentiation,lymph node metastasis,T stage,and ctDNA level after chemotherapy were all independent prognostic factor
作者
李程
闫柯
霍斌亮
李文翰
赵刚
Li Cheng;Yan Ke;Huo Binliang;Li Wenhan;Zhao Gang(Department of Oncology, Shaanxi Provincial People's Hospital, Shaanxi Province,Xi'an 710068, China;不详)
出处
《疑难病杂志》
CAS
2022年第6期566-570,581,共6页
Chinese Journal of Difficult and Complicated Cases
基金
陕西省重点研发计划项目(2021SF-125)。
