基于决策曲线分析血清E-cad、HIF-1α预测乳腺癌改良根治术治疗预后的临床研究

Prognostic study of serum E-cad and HIF-1αafter modified radical mastectomy based on decision curve analysis

目的探讨乳腺癌改良根治术患者术前血清上皮钙黏蛋白(E-cad)、缺氧诱导因子(HIF-1α)水平对患者预后的预测价值。方法纳入2018年6月至2019年6月112例接受乳腺癌改良根治术患者作为研究对象,全部患者均接受为期2年的随访,并根据2年内复发情况分为复发组与未复发组。采用χ^(2)检验、t检验比较两组患者基线资料、术前血清E-Cad、HIF-1α水平,术前血清E-Cad、HIF-1α对乳腺癌预后的影响采用COX回归分析检验,绘制受试者工作特征曲线(ROC)、决策曲线分析术前血清E-Cad、HIF-1α水平对乳腺癌改良根治术治疗预后的预测价值。结果112例乳腺癌患者改良根治术后随访2年,复发23例,复发率为20.5%(23/112);复发组患者TNM分期、淋巴结转移发生率高于未复发组,肿瘤大小、术前血清HIF-1α水平高于未复发组,术前血清E-Cad水平低于未复发组(P<0.05);经COX回归分析结果显示,TNM分期高、发生淋巴结转移、肿瘤大及术前高HIF-1α水平是乳腺癌患者术后复发的危险因素(HR=3.696、4.061、7.739、1.052,P<0.05),术前高E-Cad水平是保护因素(HR=0.313,P<0.05);绘制ROC曲线,结果显示,术前血清E-Cad、HIF-1α水平预测乳腺癌患者改良根治术治疗预后的AUC分别为0.835、0.781;绘制决策曲线,结果显示,在阈值0.2-0.6范围内,术前血清E-Cad、HIF-1α水平联合预测乳腺癌患者乳腺癌改良根治术后预后的净受益率优于二者单独预测的净受益率。结论乳腺癌患者改良根治术治疗后预后受术前血清E-Cad、HIF-1α水平的影响,且二者联合检测对乳腺癌患者改良根治术治疗预后具有较高的预测价值。

Objective To investigate the prognostic value of serum epithelial cadherin(E-cad)and hypoxia-inducing factor(HIF-1α)levels in patients undergoing modified radical mastectomy.Methods A total of 112 patients who received modified radical mastectomy from June 2018 to June 2019 were included in the study.All patients received 2-year follow-up and were divided into a recurrence group and a non-recurrence group according to the recurrence situation within 2 years.χ^(2) test and t test were used to compare the baseline data,preoperative serum E-Cad and HIF-1αlevels of the two groups.The influence of preoperative serum E-Cad and HIF-1αon the prognosis of breast cancer was tested by COX regression analysis.Receiver operating characteristic curve(ROC)and decision curve were drawn to analyze the prognostic value of preoperative serum E-Cad and HIF-1αlevels in modified radical mastectomy.Results In 112 patients with breast cancer followed up for 2 years after modified radical surgery,23 cases recurred,the recurrence rate was 20.5%(23/112).The TNM stage and the incidence of lymph node metastasis in recurrent group were higher than those in non-recurrent group,the tumor size and preoperative serum HIF-1αlevel were higher than those in non-recurrent group,and the preoperative serum E-Cad level was lower than those in non-recurrent group(P<0.05).COX regression analysis showed that high TNM stage,lymph node metastasis,large tumor and preoperative high HIF-1αlevel were risk factors for postoperative recurrence of breast cancer patients(HR=3.696,4.061,7.739,1.052,P<0.05),and preoperative high E-Cad level was protective factor(HR=0.313,P<0.05);ROC curve was drawn,and the results showed that the AUC of preoperative serum E-Cad and HIF-1αwere 0.835 and 0.781,respectively,for predicting the prognosis of breast cancer patients after modified radical surgery.The decision curve was drawn,and the results showed that the combined prediction of preoperative serum E-Cad and HIF-1αlevels for prognosis after modified radical mastectomy of breast cancer patients was superior to the net benefit rate predicted by them alone within the threshold of 0.2-0.6.Conclusion The prognosis of patients with breast cancer after modified radical surgery is affected by the levels of serum E-Cad and HIF-1αbefore surgery,and the combined detection of the two has a high predictive value for the prognosis of patients with breast cancer after modified radical surgery.