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基于ctDNA的分子残留病灶检测对非小细胞肺癌根治术后生存的预测效能
Predictive efficacy of minimal residual disease detection based on ctDNA on survival of non-small cell lung cancer after radical surgery
- 局解手术学杂志 2023年32卷第5期 页码：416-420
- 作者机构：
1.重庆医科大学第一临床学院/重庆医科大学附属第一医院全科医学科/胸外科，重庆 400016
2.重庆医科大学基础医学院，重庆 400016
3.重庆医科大学附属璧山医院胸心外科，重庆402760
- 作者简介：
梁栋，E-mail：354540166@qq.com
艾成，E-mail：nbpfh58@163.com
- 基金信息：重庆市璧山区科技项目(BSKJ20210031)
DOI：10.11659/jjssx.10E022124
中图分类号： R734.2纸质出版日期：2023-05-25，
收稿日期：2022-10-24，
扫 描 看 全 文
晨正宇,周薇,熊婧等.基于ctDNA的分子残留病灶检测对非小细胞肺癌根治术后生存的预测效能[J].局解手术学杂志,2023,32(05):416-420.
CHEN Zheng-yu,ZHOU Wei,XIONG Jing,et al.Predictive efficacy of minimal residual disease detection based on ctDNA on survival of non-small cell lung cancer after radical surgery[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(05):416-420.
晨正宇,周薇,熊婧等.基于ctDNA的分子残留病灶检测对非小细胞肺癌根治术后生存的预测效能[J].局解手术学杂志,2023,32(05):416-420. DOI： 10.11659/jjssx.10E022124.
CHEN Zheng-yu,ZHOU Wei,XIONG Jing,et al.Predictive efficacy of minimal residual disease detection based on ctDNA on survival of non-small cell lung cancer after radical surgery[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(05):416-420. DOI： 10.11659/jjssx.10E022124.
摘要
目的
2
探讨基于循环肿瘤DNA（ctDNA）的分子残留病灶（MRD）检测对非小细胞肺癌（NSCLC）患者根治术后近远期生存的预测效能。
方法
2
选取重庆医科大学附属第一医院胸外科行根治术治疗的114例NSCLC患者为研究对象，于术后1周采集患者静脉血，采用液态活检和二代测序技术检测ctDNA MRD。统计患者术后MRD阳性率，并分析其与临床病理特征的关系。记录患者术后1年、5年生存情况，采用
Kaplan
-
Meier
生存曲线比较MRD阳性和阴性患者的近远期生存率，采用
Cox
回归模型分析NSCLC根治术后近远期生存的影响因素，分析MRD检测对NSCLC根治术后近远期生存的预测效能。
结果
2
NSCLC患者术后MRD阳性率为36.84%，低/未分化、肿瘤直径
>
3 cm、纵隔淋巴结转移、TNM分期ⅢA期的NSCLC患者MRD阳性率分别高于高/中分化、肿瘤直径≤3 cm、无纵隔淋巴结转移、TNM分期Ⅰ~Ⅱ期患者（
P
<
0.05）。NSCLC患者术后1年、5年生存率分别为83.33%、52.63%，MRD阳性患者近远期生存率均低于MRD阴性患者（
P
<
0.001）。低/未分化、肿瘤直径
>
3 cm、TNM分期ⅢA期、术后MRD阳性均是影响NSCLC根治术后患者近远期生存的危险因素（
P
<
0.05），而纵隔淋巴结转移是影响NSCLC根治术后患者远期生存的危险因素（
P
<
0.05）。术后MRD预测NSCLC患者根治术后近期生存的灵敏度、特异度、准确度分别为73.68%、89.47%、76.32%，预测远期生存的灵敏度、特异度、准确度分别为95.00%、72.22%、84.21%。
结论
2
NSCLC患者MRD阳性率与肿瘤分化程度、TNM分期、肿瘤大小等有关，是影响NSCLC根治术后近远期生存的危险因素，且对近远期生存预测具有重要价值。
Abstract
Objective
2
To investigate the predictive efficacy of minimal residual disease (MRD) detection based on circulating tumor DNA (ctDNA) on the short-term and long-term survivals of patients with non-small cell lung cancer (NSCLC) after radical surgery.
Methods
2
A total of 114 patients with NSCLC who underwent radical surgery in the Department of Thoracic Surgery of First Affiliated Hospital of Chongqing Medical University were included
and the venous blood samples of patients 1 week after surgery were collected
and ctDNA MRD was detected by liquid biopsy and second-generation sequencing technology.The positive rate of MRD after surgery was counted
and its relationship with clinicopathological features was analyzed.The 1-year and 5-year survivals of patients after surgery was recorded.The short-term and long-term survival rates of MRD positive patients and negative patients were compared by
Kaplan
-
Meier
survival curve.The influencing factors of short-term and long-term survivals after NSCLC radical surgery were analyzed by
Cox
regression model
and the predictive efficacy of MRD detection on short-term and long-term survivals after NSCLC radical surgery was analyzed.
Results
2
The positive rate of MRD in NSCLC patients after surgery was 36.84%.The positive rate of MRD in NSCLC patients with low/undifferentiated tumor
tumor diameter
>
3 cm
mediastinal lymph node metastasis and TNM stage of ⅢA was higher than that in patients with high/moderate differentiation tumor
tumor diameter≤3 cm
non-metastasis of mediastinal lymph node and TNM stage of Ⅰ/Ⅱ (
P
<
0.05).The 1-year and 5-year survival rates of NSCLC patients were 83.33% and 52.63%
respectively
and the short-term and long-term survival rates in the MRD positive patients were lower than those in the MRD negative patients (
P
<
0.001).Low/undifferentiated tumor
tumor diameter
>
3 cm
TNM stage of ⅢA and postoperative MRD positive were all risk factors affecting the short-term and long-term survivals after NSCLC radical surgery (
P
<
0.05);besides
mediastinal lymph node metastases affected the long-term survival after NSCLC radical surgery (
P
<
0.05).The sensitivity
specificity and accuracy of postoperative MRD in predicting the short-term survival of NSCLC patients after radical surgery were 73.68%
89.47% and 76.32% respectively
and the sensitivity
specificity and accuracy of postoperative MRD in predicting the long-term survival were 95.00%
72.22% and 84.21% respectively.
Conclusion
2
The positive of MRD in NSCLC patients is related to the degree of tumor differentiation
TNM stage
tumor size
which is a risk factor that affects the short-term and long-term survival after NSCLC radical surgery
and has an important value for the prediction of short-term and long-term survivals.
关键词
非小细胞肺癌循环肿瘤DNA分子残留病灶根治术生存
Keywords
non-small cell lung cancercirculating tumor DNAminimal residual diseaseradical surgerysurvival
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