摘要
目的分析叶酸受体阳性循环肿瘤细胞(FR+-CTCs)对实施根治术的结直肠癌(CRC)患者预后的预测价值。方法回顾性分析2021年3月至2022年10月于梅州市人民医院接受根治术的142例CRC患者,根据患者完成随访情况将其分为无病组(98例)和进展组(44例),比较两组患者一般资料、术前FR+-CTCs水平,采用Cox回归分析影响CRC患者预后的独立危险因素,并构建预测CRC患者预后的列线图模型,评估模型价值。按照患者术前FR+-CTCs水平最佳截断值,将142例患者分为高水平组(52例)和低水平组(90例),比较两组无病生存期(DFS)。结果进展组患者年龄、肿瘤最大直径、术前FR+-CTCs水平、Dukes分期中C1分期占比、低分化占比均高于无病组(P<0.05)。多因素Cox回归结果显示,年龄、肿瘤最大直径、Dukes分期、分化程度、术前FR+-CTCs水平均为影响CRC患者预后的独立危险因素(P<0.05)。建立列线图预测模型,训练集和验证集中模型的曲线下面积(AUC)均为0.95;Hosmer-Lemeshow拟合优度检验显示,验证集χ^(2)=3.164,P=0.924;决策曲线显示验证集阈值概率在0.02~0.96时,模型能产生更好的临床效益。随访截至2024年11月,高水平组患者DFS显著短于低水平组(P<0.05)。结论FR+-CTCs是影响CRC患者预后的独立危险因素,其与传统临床病理因素结合的列线图为DFS预测提供了实用工具,有望优化CRC个体化治疗策略。
Objective To analyze the prognostic value of folate receptor-positive circulating tumor cells(FR+-CTCs)in colorectal cancer(CRC)patients undergoing radical resection.Methods A retrospective analysis was conducted on 142 CRC patients who underwent radical resection at Meizhou People's Hospital from March 2021 to October 2022.The patients were classified into a disease-free group(n=98)and a progression group(n=44).General clinical data and preoperative FR+-CTCs levels were compared between groups.Cox regression analysis was used to identify independent risk factors affecting CRC prognosis,and a nomogram prediction model was constructed.The model's value was assessed.Based on the optimal cut-off value of preoperative FR+-CTCs levels,the 142 patients were divided into a high-level group(n=52)and a low-level group(n=90).Disease-free survival(DFS)was compared between these groups.Results Age,maximum tumor diameter,preoperative FR+-CTCs levels,proportion of Dukes C1 stage,and proportion of poor differentiation were significantly higher in the progression group than in the disease-free group(P<0.05).Multivariate Cox regression showed that age,maximum tumor diameter,Dukes stage,differentiation degree,and preoperative FR+-CTCs level were independent risk factors for CRC prognosis(P<0.05).The constructed nomogram model had an area under the curve(AUC)of 0.95 in both the training and validation sets.Hosmer-Lemeshow goodness-of-fit test showedχ^(2)=3.164(P=0.924)for the validation set.Decision curve analysis indicated better clinical net benefit when the validation set threshold probability was 0.02–0.96.At follow-up until November 2024,the high-level group had significantly shorter DFS than the low-level group(P<0.05).Conclusion FR+-CTCs is an independent risk factor affecting CRC prognosis.The nomogram combining FR+-CTCs with traditional clinicopathological factors provides a practical tool for DFS prediction,which is expected to optimize individualized treatment strategies for CRC.
作者
张日雄
吴祖光
刘凡
陈文局
刘宏涛
饶辉
李运霖
ZHANG Rixiong;WU Zuguang;LIU Fan;CHEN Wenju;LIU Hongtao;RAO Hui;LI Yunlin(Department of Gastrointestinal Surgery,Meizhou People's Hospital,Meizhou,Guangdong 514000,China;Administrative Office,Meizhou People's Hospital,Meizhou,Guangdong 514000,China;Clinical Laboratory Center,Meizhou People's Hospital,Meizhou,Guangdong 514000,China)
出处
《转化医学杂志》
2025年第7期95-100,共6页
Translational Medicine Journal
基金
广东省中医药局科研项目(20241325)
梅州市科技计划项目(211130092050186)。
关键词
叶酸受体阳性循环肿瘤细胞
结直肠癌根治术
预后
列线图
无病生存期
Folate receptor-positive circulating tumor cells
Radical resection for colorectal cancer
Prognosis
nomogram
Disease-free survival
