血清miR-25-3p、CXCL12水平与非小细胞肺癌患者胸腔镜肺叶切除术后预后的关系分析

Relationship between serum miR-25-3p,CXCL12 level and prognosis of patients with non-small cell lung cancer after thoracoscopic lobectomy

目的:分析血清miR-25-3p、脊髓趋化因子CXC配体12(CXCL12)与非小细胞肺癌(non-small cell lung cancer,NSCLC)患者胸腔镜肺叶切除术后预后的关系。方法:选择2017年02月至2020年07月医院收治的175例NSCLC患者,所有患者均接受胸腔镜肺叶切除术治疗。术前检测患者血清miR-25-3p、CXCL12水平,术后随访3年,根据患者预后情况分为预后不良组(复发转移)与预后良好组(非复发转移)。对比预后不良组与预后良好组血清miR-25-3p、CXCL12水平,对比预后不良组与预后良好组的临床资料,分析NSCLC患者术后预后不良的影响因素,分析血清miR-25-3p、CXCL12水平及二者联合对NSCLC患者术后预后不良的预测价值。结果:随访3年,175例患者失访6例,随访率为96.57%,其中复发转移31例,复发转移率为18.34%,剩余138例均未发生复发转移,中位复发转移时间为24.75个月(95%CI:18.32~28.47)。预后不良组血清miR-25-3p、CXCL12水平高于预后良好组(P<0.05)。预后不良组Ⅱ期、低分化例数占比高于预后良好组(P<0.05)。多因素Cox回归分析结果显示,Ⅱ期(HR=3.827,95%CI:1.682~8.705)、低分化(HR=3.466,95%CI:1.524~7.884)、血清miR-25-3p(HR=2.732,95%CI:1.201~6.215)、血清CXCL12(HR=3.152,95%CI:1.386~7.170)为NSCLC患者术后预后不良的影响因素(P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线结果显示,血清miR-25-3p、CXCL12水平及二者联合预测NSCLC患者术后预后不良的灵敏度分别为80.65%(95%CI:0.627~0.853)、83.87%(95%CI:0.641~0.869)、93.55%(95%CI:0.782~0.973),特异度分别为78.26%(95%CI:0.602~0.835)、76.09%(95%CI:0.584~0.791)、91.30%(95%CI:0.769~0.934),曲线下面积(area under curve,AUC)值分别为0.767、0.755、0.908(P<0.05),且二者联合的AUC值更高(P<0.05)。结论:术前检测血清miR-25-3p、CXCL12水平可用于预测NSCLC患者胸腔镜肺叶切除术后预后,且二者联合的预测价值更高。

Objective:To analyze the relationship between serum miR-25-3p,spinal cord chemokine CXC ligand 12(CXCL12)and prognosis of patients with non-small cell lung cancer(NSCLC)after thoracoscopic lobectomy.Methods:A total of 175 patients with NSCLC admitted to the hospital from February 2017 to July 2020 were selected,all of whom underwent thoracoscopic lobectomy.Serum miR-25-3p and CXCL12 levels were detected before operation.After 3 years of follow-up,patients were divided into poor prognosis group(recurrence and metastasis)and good prognosis group(non-recurrence and metastasis)according to the prognosis.The levels of serum miR-25-3p and CXCL12 in the poor prognosis group and the good prognosis group were compared,and the clinical data of the poor prognosis group and the good prognosis group were compared,and the influencing factors of the poor prognosis in patients with NSCLC after surgery were analyzed.The predictive value of serum miR-25-3p and CXCL12 levels and their combination on postoperative poor prognosis of patients with NSCLC were analyzed.Results:After 3 years of follow-up,6 of 175 patients were lost to follow-up,the follow-up rate was 96.57%,including 31 patients with recurrence and metastasis,the recurrence and metastasis rate was 18.34%,and the remaining 138 patients did not have recurrence and metastasis,the median time of recurrence and metastasis was 24.75 months(95%CI:18.32~28.47).The levels of miR-25-3p and CXCL12 in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The proportion of stageⅡand low differentiation cases in poor prognosis group was higher than that in good prognosis group(P<0.05).Multivariate Cox regression analysis results showed that stageⅡ(HR=3.827,95%CI:1.682~8.705),low differentiation(HR=3.466,95%CI:1.524~7.884),serum miR-25-3p(HR=2.732,95%CI:1.201~6.215)and serum CXCL12(HR=3.152,95%CI:1.386~7.170)were the influential factors for poor prognosis of patients with NSCLC after surgery(P<0.05).Receiver operating characteristic curve(ROC)results showed that the sensitivity of serum miR-25-3p and CXCL12 levels and their combination in predicting postoperative poor prognosis of NSCLC patients were 80.65%(95%CI:0.627~0.853)and 83.87%(95%CI:0.641~0.869),93.55%(95%CI:0.782~0.973),the specificity was 78.26%(95%CI:0.602~0.835),76.09%(95%CI:0.584~0.791),91.30%(95%CI:0.769~0.934),the area under the curve(AUC)values were 0.767,0.755 and 0.908(P<0.05),and the AUC values of the two combined were higher(P<0.05).Conclusion:Preoperative detection of serum miR-25-3p and CXCL12 levels can be used to predict the prognosis of NSCLC patients after thoracoscopic lobectomy,and the combination of miR-25-3p and CXCL12 levels has higher predictive value.