血浆循环肿瘤DNA与宫颈癌临床病理、疗效及预后的关系

Relationship between circulating tumor DNA in plasma and clinicopathology,efficacy and prognosis of cervical cancer

目的:探讨血浆循环肿瘤DNA(circulating tumor DNA,ctDNA)与宫颈癌临床病理、疗效及预后之间的关系。方法:188例宫颈癌患者设为宫颈癌组,200例健康女性为健康对照组。收集宫颈癌组治疗前后和健康对照组空腹静脉血5mL,检测血浆ctDNA含量;对比分析两组血浆ctDNA含量差异,并分析其与患者临床病理、疗效及预后之间的关系。结果:宫颈癌组和健康对照组ctDNA含量分别为(15.76±3.18)ng/mL和(7.82±1.63)ng/mL,两组ctDNA含量比较差异显著,有统计学意义(t=31.218,P=0.001)。ctDNA含量在组织学分级、浸润间质深度、淋巴转移及FIGO分期上差异显著,有统计学意义(P<0.05),以高分化、浸润间质深度≥1/2、存在淋巴转移及FIGO III期者为ctDNA高表达者居多,反之则为低表达者;但在年龄、肿瘤大小和是否累积子宫下段上差异无统计学意义(P>0.05)。治疗前后宫颈癌ctDNA含量分别为(15.76±3.18)ng/mL和(10.37±2.69)ng/mL,两者ctDNA含量比较差异显著,有统计学意义(t=17.743,P=0.001)。随访3年,与高表达者比较,低表达者DFS生存率和OS生存率明显增高(44.12%vs.62.79%;47.06%vs.67.44%),差异有统计学意义(χ^2=6.526,P=0.011;χ^2=7.883,P=0.005)。经多因素COX回归分析得知,有淋巴转移、FIGO III期和ctDNA高表达是影响宫颈癌预后的独立危险因素(P<0.05)。结论:宫颈癌患者中血浆ctDNA含量较高,在不同组织学分级、浸润间质深度、淋巴转移及FIGO分期等临床病理特征上差异明显,与治疗及预后相关,有望成为宫颈癌临床诊疗及预后检测的有效指标。

Objective:To investigate the relationship between circulating tumor DNA(ctDNA)in plasma and clinicopathology,efficacy and prognosis of cervical cancer.Methods:188 patients with cervical cancer were selected as the study subjects and named as cervical cancer group.Meanwhile,200 healthy women were selected as the control group and named as healthy control group.Fasting venous blood 5 ml was collected before and after treatment in cervical cancer group and healthy control group,and plasma ctDNA content was detected.The difference of plasma ctDNA content between the two groups was compared and analyzed.The relationship between plasma ctDNA content and clinical pathology,curative effect and prognosis was also analyzed.Results:The contents of ctDNA in cervical cancer group and healthy control group were(15.76±3.18)and(7.82±1.63)ng/mL,respectively,there was significant difference in the contents of ctDNA between the two groups(t=31.218,P=0.001).The content of ctDNA was significantly different in histological grade,depth of infiltrating stroma,lymphatic metastasis and FIGO staging(P<0.05).Highly differentiated,infiltrating stromal depth(>1/2),lymphatic metastasis and FIGO III stage were the most frequently expressed ctDNA,whereas low expressed ctDNA.However,there was no significant difference in age,tumor size and cumulative lower uterine segment(P>0.05).The ctDNA before and after the treatment of cervical cancer were(15.76±3.18)and(10.37±2.69)ng/mL,the ctDNA content of the difference was statistically significant(t=17.743,P=0.001).Following up for 3 years,the survival rates of DFS and OS in low expression group were significantly higher than those in high expression group(44.12%vs.62.79%and 47.06%vs.67.44%)and the difference was statistically significant(χ^2=6.526,P=0.011 andχ^2=7.883,P=0.005).The multivariate COX regression analysis showed that lymphatic metastasis,FIGO III stage and high expression of ctDNA were independent risk factors affecting the prognosis of cervical cancer(P<0.05).Conclusion:The content of plasma ctDNA in patients with cervical cancer is high.There are significant differences in clinicopathological features such as different histological grades,depth of infiltration stroma,lymphatic metastasis and FIGO staging,which are related to treatment and prognosis.It is expected to become an effective index for clinical diagnosis,treatment and prognosis detection of cervical cancer.