血清TSGF、MCP-1、Ang-2与腹腔镜下子宫肌瘤剔除术后复发的关系及列线图预测模型构建

Study on the Relationship between Serum TSGF, MCP-1, Ang-2 and Recurrence after Laparoscopic Myomectomy and the Construction of a Nomograph Prediction Model

目的:探究血清肿瘤特异性生长因子(TSGF)、单核细胞趋化蛋白-1(MCP-1)、血管生成素2(Ang-2)与腹腔镜下子宫肌瘤剔除术(LM)术后复发的关系及列线图预测模型构建。方法:纳入2018年6月至2020年6月我院收治的213例行LM的子宫肌瘤患者作为研究对象。检测所有患者的血清TSGF、MCP-1、Ang-2水平。随访3年,根据术后3年是否复发分为复发组与未复发组,比较两组血清TSGF、MCP-1、Ang-2水平。采用单因素及多因素Logistic回归分析子宫肌瘤患者LM术后复发的危险因素,根据危险因素构建术后复发风险列线图预测模型。采用受试者工作特征(ROC)曲线分析血清MCP-1、TSGF、Ang-2对子宫肌瘤患者LM术后复发的预测效能。结果:213例子宫肌瘤LM患者随访3年,失访者8例,205例子宫肌瘤患者LM术后3年复发37例,复发率为18.05%(37/205)。未复发组血清Ang-2、TSGF、MCP-1水平均低于复发组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术后肌瘤残留、血清TSGF升高、年龄≥35岁、MCP-1升高、多发肌瘤、Ang-2升高为子宫肌瘤患者LM术后复发的独立危险因素(P<0.05)。ROC分析显示,血清TSGF、MCP-1、Ang-2、列线图预测模型的曲线下面积(AUC)为0.873(95%CI:0.801~0.944)、0.721(95%CI:0.624~0.817)、0.803(95%CI:0.722~0.885)、0.986(95%CI:0.973~0.998)。内部验证(B=1000)显示,C-index为0.972,提示该列线图预测模型预测能力较好。决策分析显示,该模型的阈值概率0.01~0.95,净收益率>0,高于两条无效线。结论:血清TSGF、MCP-1、Ang-2水平升高可导致子宫肌瘤患者LM术后复发。年龄≥35岁、多发肌瘤、术后肌瘤残留、血清TSGF升高、MCP-1升高、Ang-2升高为子宫肌瘤患者LM术后复发的独立危险因素。依据独立危险因素构建的列线图预测模型对子宫肌瘤患者LM术后复发具有良好预测价值。

Objective:To explore the relationship between serum tumor specific growth factor(TSGF),monocyte chemoattractant protein-1(MCP-1),angiopoietin-2(Ang-2)and recurrence after laparoscopic myomectomy(LM)and the construction of a nomograph prediction model.Methods:213 uterine fibroids patients who were undergoing LM surgery admitted to our hospital from June 2018 to June 2020 were selected as study subjects.The serum levels of TSGF,MCP-1 and Ang-2 were detected in all patients.After 3 years of follow-up,patients were divided into recurrence group and non-recurrence group according to whether patients had recurred 3 years after operation,the serum levels of TSGF,MCP-1 and Ang-2 were compared between two groups.The risk factors of recurrence after LM in uterine fibroids patients were analyzed by univariate and multivariate Logistic regression analysis,and a nomograph prediction model for postoperative recurrence risk was constructed according to the risk factors.The predictive efficacy of serum MCP-1,TSGF and Ang-2 on the recurrence of LM in uterine fibroids patients were analyzed by receiver operating characteristic(ROC)curve.Results:213 uterine fibroids patients were followed up for 3 years,and 8 patients were lost to follow-up,there were 37 cases of recurrence in 205 uterine fibroids patients 3 years after LM,and the recurrence rate was 18.05%(37/205).The serum levels of Ang-2,MCP-1 and TSGF in non-recurrence group were lower than those in recurrence group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that,postoperative residual myoma,elevated serum TSGF,age≥35 years,elevated MCP-1,multiple fibroids and elevated Ang-2 were independent risk factors for recurrence after LM in uterine fibroids patients(P<0.05).ROC analysis showed that,the area under the curve(AUC)of serum TSGF,MCP-1,Ang-2 and nomograph prediction model was 0.873(95%CI:0.801~0.944),0.721(95%CI:0.624~0.817),0.803(95%CI:0.722~0.885),0.986(95%CI:0.973~0.998).Internal validation(B=1000)showed that,the C-index was 0.972,suggesting that the nomograph prediction model had a good predictive ability.The decision analysis shows that,the threshold probability of the model was 0.01~0.95,and the net return rate was>0,which was higher than the two invalid lines.Conclusion:The increase of serum TSGF,MCP-1 and Ang-2 levels can lead to the recurrence of LM in uterine fibroids patients.Age≥35 years old,multiple fibroids,postoperative residual myoma,elevated serum TSGF,elevated MCP-1 and elevated Ang-2 are independent risk factors for recurrence after LM in uterine fibroids patients.The nomograph prediction model base on independent risk factors has a good predictive value for the recurrence of LM in uterine fibroids patients.