Circulating tumor DNA in liquid biopsy: Current diagnostic limitation

With the rapid development of science and technology,cell-free DNA(cfDNA)is rapidly becoming an important biomarker for tumor diagnosis,monitoring and prognosis,and this cfDNA-based liquid biopsy technology has great potential to become an important part of precision medicine.cfDNA is the total amount of free DNA in the systemic circulation,including DNA fragments derived from tumor cells and all other somatic cells.Tumor cells release fragments of DNA into the bloodstream,and this source of cfDNA is called circulating tumor DNA(ctDNA).cfDNA detection has become a major focus in the field of tumor research in recent years,which provides a new opportunity for non-invasive diagnosis and prognosis of cancer.In this paper,we discuss the limitations of the study on the origin and dynamics analysis of ctDNA,and how to solve these problems in the future.Although the future faces major challenges,it also con-tains great potential.

Circulating tumor DNA and its role in detection, prognosis and therapeutics of hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is considered the fifth most prevalent cancer among all types of cancers and has the third most morbidity value. It has the most frequent duplication time and a high recurrence rate. Recently, the most unique technique used is liquid biopsies, which carry many markers;the most prominent is circulating tumor DNA(ctDNA). Varied methods are used to investigate ctDNA, including various forms of polymerase chain reaction(PCR) [emulsion PCR(ePCR), digital PCR(dPCR), and bead, emulsion, amplification, magnetic(BEAMing) PCR]. Hence ctDNA is being recognized as a potential biomarker that permits early cancer detection,treatment monitoring, and predictive data on tumor burden are subjective to therapy or surgery. Numerous ctDNA biomarkers have been investigated based on their alterations such as 1) single nucleotide variations(either insertion or deletion of a nucleotide) markers including TP53, KRAS, and CCND1;2) copy number variations which include markers such as CDK6, EFGR, MYC and BRAF;3) DNA methylation(RASSF1A, SEPT9, KMT2C and CCNA2);4) homozygous mutation includes ctDNA markers as CDKN2A, AXIN1;and 5) gain or loss of function of the genes, particularly for HCC. Various researchers have conducted many studies and gotten fruitful results.Still, there are some drawbacks to ctDNA namely low quantity, fragment heterogeneity, less stability, limited mutant copies and standards, and differential sensitivity. However, plenty of investigations demonstrate ctDNA's significance as a polyvalent biomarker for cancer and can be viewed as a future diagnostic, prognostic and therapeutic agent. This article overviews many conditions in genetic changes linked to the onset and development of HCC, such as dysregulated signaling pathways, somatic mutations, single-nucleotide polymorphisms, and genomic instability. Additionally, efforts are also made to develop treatments for HCC that are molecularly targeted and to unravel some of the genetic pathways that facilitate its early identification.

Development and validation of a circulating tumor DNA-based optimization-prediction model for short-term postoperative recurrence of endometrial cancer

BACKGROUND Endometrial cancer(EC)is a common gynecological malignancy that typically requires prompt surgical intervention;however,the advantage of surgical management is limited by the high postoperative recurrence rates and adverse outcomes.Previous studies have highlighted the prognostic potential of circulating tumor DNA(ctDNA)monitoring for minimal residual disease in patients with EC.AIM To develop and validate an optimized ctDNA-based model for predicting shortterm postoperative EC recurrence.METHODS We retrospectively analyzed 294 EC patients treated surgically from 2015-2019 to devise a short-term recurrence prediction model,which was validated on 143 EC patients operated between 2020 and 2021.Prognostic factors were identified using univariate Cox,Lasso,and multivariate Cox regressions.A nomogram was created to predict the 1,1.5,and 2-year recurrence-free survival(RFS).Model performance was assessed via receiver operating characteristic(ROC),calibration,and decision curve analyses(DCA),leading to a recurrence risk stratification system.RESULTS Based on the regression analysis and the nomogram created,patients with postoperative ctDNA-negativity,postoperative carcinoembryonic antigen 125(CA125)levels of<19 U/mL,and grade G1 tumors had improved RFS after surgery.The nomogram’s efficacy for recurrence prediction was confirmed through ROC analysis,calibration curves,and DCA methods,highlighting its high accuracy and clinical utility.Furthermore,using the nomogram,the patients were successfully classified into three risk subgroups.CONCLUSION The nomogram accurately predicted RFS after EC surgery at 1,1.5,and 2 years.This model will help clinicians personalize treatments,stratify risks,and enhance clinical outcomes for patients with EC.

ctDNA检测在非小细胞肺癌临床诊疗应用中的最新研究进展

非小细胞肺癌(non-small cell lung cancer,NSCLC)是一种高度致死性的恶性肿瘤,给人类健康带来严重威胁。传统的肿瘤诊疗方法存在许多局限性,而液体活检技术中的循环肿瘤DNA(circulating tumor DNA,ctDNA)检测由于其无创便捷、全面灵敏的特点,在NSCLC的个体化治疗和监测中引起了广泛关注。该文将综述近年来ctDNA检测在NSCLC临床诊疗应用中的最新研究进展,包括其在早期筛查、疾病诊断、肿瘤突变监测、治疗效果评估以及预后评估等方面的应用。

动态监测ctDNA⁃MRD预测局部晚期NSCLC放化疗疗效

1文献来源Pan Y,Zhang JT,Gao X,et al.Dynamic circulating tumor DNA during chemoradiotherapy predicts clinical outcomes for locally advanced non⁃small cell lung cancer patients[J].Cancer Cell,2023,41(10):1763-1773.e4.2证据水平2b。

Circulating tumor cells and circulating tumor DNA in breast cancer diagnosis and monitoring

Liquid biopsy,including both circulating tumor cells and circulating tumor DNA,is becoming more popular as a diagnostic tool in the clinical management of breast cancer.Elevated concentrations of these biomarkers during cancer treatment may be used as markers for cancer progression as well as to understand the mechanisms underlying metastasis and treatment resistance.Thus,these circulating markers serve as tools for cancer assessing and monitoring through a simple,non-invasive blood draw.However,despite several study results currently noting a potential clinical impact of ctDNA mutation tracking,the method is not used clinically in cancer diagnosis among patients and more studies are required to confirm it.This review focuses on understanding circulating tumor biomarkers,especially in breast cancer.

NSCLC患者ctDNA与病理组织中EGFR、PIK3CA基因突变检测结果一致性及影响因素

目的探讨非小细胞肺癌(NSCLC)患者外周血中循环肿瘤DNA(ctDNA)与病理组织中上皮生长因子受体(EGFR)、磷脂酰肌醇3-激酶催化亚基α(PIK3CA)基因突变检测结果的一致性,并分析其影响因素。方法纳入2019年12月—2020年12月我院收治的118例NSCLC患者作为研究对象。检测患者外周血ctDNA及病理组织中EGFR、PIK3CA及c-Met、TP53、FGFR1、BRAF、STK11、FANCA、KRAS、ERBB2基因状态,比较ctDNA与组织中EGFR、PIK3CA检测结果的一致性,并将患者分为一致组和非一致组;比较两组患者的临床资料,多因素Logistic回归分析影响检测结果一致性的因素;Kaplan-Meier法绘制生存曲线分析ctDNA检测EGFR、PIK3CA突变患者1年生存情况。结果ctDNA检测结果显示,84例(71.19%)患者检出至少1个EGFR突变位点,19del、L858R、T790M突变检出率分别为37.29%、23.73%、33.05%,33例(27.97%)检出至少1个PIK3CA突变位点,p.E545K、p.H1047R、p.E542K突变检出率分别为15.25%、9.32%、4.24%;组织检测结果显示,EGFR突变检出率为65.25%(77/118),19del、L858R、T790M突变检出率分别为35.59%、23.73%、31.36%,PIK3CA突变检出率为21.19%(25/118),p.E545K、p.H1047R、p.E542K突变检出率分别为12.71%、7.63%、3.39%;ctDNA中c-Met、TP53、FGFR1、BRAF、STK11、FANCA、KRAS、ERBB2突变检出率分别为1.69%、22.03%、2.54%、4.24%、5.08%、3.39%、1.69%、1.69%,组织中分别为5.93%、33.05%、2.54%、2.54%、5.08%、3.39%、2.54%、3.39%。ctDNA与组织检测EGFR、PIK3CA及总体的一致率分别为77.12%、71.19%和64.41%(Kappa=0.348,0.537,0.645)。多因素分析结果显示,肿瘤低分化、肿瘤分期Ⅳ期、骨转移、初诊未治是外周血ctDNA与组织中EGFR、PIK3CA基因突变检测一致性的独立危险因素(P<0.05)。ctDNA检测EGFR突变阳性患者生存率明显低于阴性患者,PIK3C A突变阳性患者生存率明显低于阴性患者(P<0.05)。结论外周血ctDNA与组织DNA检测PIK3CA的一致性良好,检测EGFR的一致性较差,肿瘤分化程度、分期、骨转移及初诊治疗情况均与检测一致性有关。

PLR、微卫星状态及ctDNA对肢端恶性黑色素瘤术后复发的评估作用

目的 探讨外周血血小板/淋巴细胞比值(PLR)、微卫星状态及血浆循环肿瘤DNA(ctDNA)对肢端恶性黑色素瘤(AM)术后复发的评估作用。方法 选择行外科手术治疗的AM患者98例,收集患者临床资料,分析不同临床分期患者PLR、微卫星状态、ctDNA差异,采用Logistic回归分析影响患者术后复发的相关因素,建立ROC曲线分析PLR、MS、ctDNA对术后复发的诊断价值。结果 随临床分期增加,PLR、ctDNA水平、微卫星不稳定(MSI)占比逐渐增加(P<0.05);98例AM患者术后1年复发21例(21.43%),多因素Logistic回归分析显示,肿瘤厚度、病理分型、PLR、ctDNA值、MSI占比是AM术后复发的影响因素(P<0.05);ROC曲线显示,PLR、ctDNA、微卫星状态诊断术后复发的AUC分别为0.784、0.858、0.816。结论 PLR、ctDNA值及微卫星状态与AM患者病情严重程度有关,对患者术后复发具有一定的评估价值。

循环肿瘤DNA在膀胱癌中的研究进展及临床价值

随着生物技术的发展,液体活检技术在肿瘤方面的研究逐渐深入,循环肿瘤DNA(ctDNA)作为液体活检的主要方式之一,以其非侵入性、可重复性及可早期发现病变等特点备受关注。目前有研究表明ctDNA在膀胱癌(BCa)的早期诊断和分级、靶向治疗的选择和疗效分析、肿瘤的复发及进展等方面有一定的潜能,本文结合ctDNA的特点及其近年来在BCa中的研究进展和临床价值进行综述。ctDNA检测技术近年不断发展,人们在测序、突变测定技术发展及在增强其作为癌症检测生物标志物能力方面做出多项进展与尝试。对血浆样本中ctDNA的检测有助于在早期BCa的诊断中实现准确分类,但由于ctDNA含量低,需要更先进检测技术的支持;基于靶向测序的ctDNA分析是预测非肌层浸润性膀胱癌(NMIBC)患者疾病复发和侵袭性的一种有希望的方法。在晚期BCa患者中,可以应用ctDNA收集特有突变类型的特点,有针对性地指导用药、调整治疗及监测预后。尽管ctDNA在BCa的应用仍存在挑战,但已表现出广泛的应用前景。

脑脊液ctDNA活检在髓母细胞瘤的研究进展

髓母细胞瘤(MB)是儿童常见的中枢神经系统恶性肿瘤之一,分析肿瘤分子特征有助于MB的临床诊断、治疗及预后。脑脊液循环肿瘤DNA(ctDNA)分析能弥补临床组织活检进行分子分析的不足,为MB的诊断与监测提供更加精确、动态的分子信息。该文就脑脊液ctDNA活检在MB中的研究进展进行系统性综述。

ctDNA在结直肠癌患者全程管理中的临床应用现状及展望

循环肿瘤DNA(ctDNA)是来自于凋亡/坏死肿瘤细胞释放到体液中的单链和双链DNA片段,具有与肿瘤组织相似的遗传构成。结直肠癌(CRC)患者体液中的ctDNA携带肿瘤细胞的遗传特征并描述肿瘤组织的分子学特性。越来越多的研究表明ctDNA在CRC早期诊断、围手术期全程管理以及辅助晚期治疗等各个方面都发挥一定的应用价值。该文就ctDNA在CRC发生发展各个阶段中的应用现状作一综述。

血清ctDNA及miR-21、IL-17、vWF与弥漫大B细胞淋巴瘤患者R-CHOP疗效的关系研究

目的探讨血清循环肿瘤DNA(ctDNA)及微小核糖核酸-21(miR-21)、白细胞介素-17(IL-17)、血管性血友病因子(vWF)与弥漫大B细胞淋巴瘤(DLBCL)患者R-CHOP疗效的关系。方法选取2016年4月至2022年4月在该院确诊并收治的109例DLBCL患者为研究对象,分析其治疗前后的血清ctDNA、miR-21、IL-17、vWF水平,比较DLBCL患者R-CHOP疗效无效和有效组的资料情况及血清ctDNA、miR-21、IL-17、vWF水平,多因素Logistic回归模型研究DLBCL患者R-CHOP疗效的影响因素,受试者工作特征(ROC)曲线评估上述4个指标预测DLBCL患者R-CHOP疗效的效能。结果与治疗前比较,DLBCL患者治疗后血清ctDNA、miR-21、vWF水平明显降低,IL-17水平明显增高,差异有统计学意义(P<0.05)。与有效组比较,无效组Ann Arbor分期(Ⅰ~Ⅱ期/Ⅲ~Ⅳ期)、国际预后指数(IPI)评分(0~2分/3~5分)、脾大(否/是)、贫血(否/是)、乳酸脱氢酶≥220 IU/L(否/是)、球蛋白>34 g/L(否/是)、化疗期间感染(否/是)比例及血清ctDNA、miR-21、vWF水平明显增高,IL-17水平明显降低,差异有统计学意义(P<0.05)。IPI评分3~5分及血清ctDNA、miR-21、IL-17、vWF水平为DLBCL患者R-CHOP疗效的影响因素(P<0.05)。绘制ROC曲线发现,血清ctDNA、miR-21、IL-17、vWF联合预测DLBCL患者R-CHOP疗效的效能[曲线下面积(AUC)=0.821]要高于各指标单独应用(AUC=0.706、0.652、0.638、0.677),其预测灵敏度与特异度依次为66.72%、92.32%,截断值依次为102.9 ng/mL、1.59、8.51 pg/mL、9.61μg/mL。结论血清ctDNA、miR-21、vWF增高及IL-17降低的DLBCL患者其R-CHOP疗效较差,4个指标对DLBCL患者R-CHOP疗效有一定预测价值,有望成为DLBCL疗效评估的潜在标志物。

Cell-free circulating tumor DNA in cancer

Cancer is a common cause of death worldwide.Despite significant advances in cancer treatments,the morbidity and mortality are still enormous.Tumor heterogeneity,especially intratumoral heterogeneity,is a significant reason underlying difficulties in tumor treatment and failure of a number of current therapeutic modalities,even of molecularly targeted therapies.The development of a virtually noninvasive "liquid biopsy" from the blood has been attempted to characterize tumor heterogeneity.This review focuses on cell-free circulating tumor DNA(ctDNA) in the bloodstream as a versatile biomarker.ctDNA analysis is an evolving field with many new methods being developed and optimized to be able to successfully extract and analyze ctDNA,which has vast clinical applications.ctDNA has the potential to accurately genotype the tumor and identify personalized genetic and epigenetic alterations of the entire tumor.In addition,ctDNA has the potential to accurately monitor tumor burden and treatment response,while also being able to monitor minimal residual disease,reducing the need for harmful adjuvant chemotherapy and allowing more rapid detection of relapse.There are still many challenges that need to be overcome prior to this biomarker getting wide adoption in the clinical world,including optimization,standardization,and large multicenter trials.

ctDNA在肝细胞癌诊断、预后及治疗中的应用进展

精准医疗在肝细胞癌(HCC)中的应用有望改善不良预后和高死亡率,而液体活检为精准肿瘤学提供了良好的前景。循环肿瘤DNA(ctDNA)作为液体活检的重要组成部分,主要从原发肿瘤、转移灶的坏死细胞或凋亡细胞中释放,携带肿瘤细胞的基因变异信息,在肿瘤进展的早期阶段即可监测到,有助于及时反映患者的肿瘤负荷,在HCC早期诊断、疗效评价及预后分析中作为一种新型的肿瘤分子标志物具有巨大潜力。ctDNA检测是非侵入性的,具有无创、多时间点监测、肿瘤定性、耐药机制确定等优势,可支持对肿瘤进行实时、全方位的动态监测,以分析肿瘤复发、转移或治疗反应。本文就ctDNA在HCC诊断、预后预测及治疗中的应用研究进展作一综述。

Circulating tumor DNA as a liquid biopsy target for detection of pancreatic cancer

Most pancreatic cancer patients present with advanced metastatic disease, resulting in extremely poor 5-year survival, mainly because of the lack of a reliable modality for early detection and limited therapeutic options for advanced disease. Therefore, there is a need for minimally-invasive diagnostic tools for detecting pancreatic cancer at an early stage, when curative surgery and also novel therapeutic approaches including precision medicine may be feasible. The "liquid biopsy" addresses these unmet clinical needs based on the concept that simple peripheral blood sampling and detection of circulating tumor DNA(ct DNA) could provide diagnostic information. In this review, we provide an overview of the current status of bloodbased tests for diagnosis of pancreatic cancer and the potential utility of ct DNA for precision medicine. We also discuss challenges that remain to be addressed in developing practical ct DNA-based liquid biopsy approaches for early diagnosis of pancreatic cancer.

循环肿瘤DNA的检测技术及在癌症诊疗中的应用价值

循环肿瘤DNA(ctDNA)来源于肿瘤,能很好地反映肿瘤的基因信息,并且会随着肿瘤的进展发生相应的改变。近年来,ctDNA独特的能力备受人们关注并被广泛研究,本文在总结ctDNA的来源、性质和样品处理的基础上,对ctDNA的检测技术及在癌症诊疗中的应用进行综述,阐述了ctDNA标准物质在二代测序中的作用及重要性,并指出ctDNA样品的收集、存储、定量检测以及数据分析等各个流程中建立统一标准及规范的迫切性。

Significance of postoperative follow-up of patients with metastatic colorectal cancer using circulating tumor DNA

BACKGROUND One of the most notable applications for circulating tumor DNA(ctDNA)detection in peripheral blood of patients with metastatic colorectal cancer(mCRC)is a long-term postoperative follow-up.Sometimes referred to as a“liquid(re)biopsy”it is a minimally invasive procedure and can be performed repeatedly at relatively short intervals(months or even weeks).The presence of the disease and the actual extent of the tumor burden(tumor mass)within the patient’s body can be monitored.This is of particular importance,especially when evaluating radicality of surgical treatment as well as for early detection of disease progression or recurrence.AIM To confirm the radicality of surgery using ctDNA and compare available methods for detection of recurrence in metastatic colorectal cancer.METHODSA total of 47 patients with detected ctDNA and indications for resection of mCRC were enrolled in the multicenter study involving three surgical centers.Standard postoperative follow-ups using imaging techniques and the determination of tumor markers were supplemented by ctDNA sampling.In addition to the baseline ctDNA testing prior to surgery,a postoperative observation was conducted by evaluating ctDNA presence up to a week after surgery and subsequently at approximately three-month intervals.The presence of ctDNA was correlated with radicality of surgical treatment and the actual clinical status of the patient.RESULTS Among the monitored patients,the R0(curative)resection correlated with postoperative ctDNA negativity in 26 out of 28 cases of surgical procedures(26/28,93%).In the remaining cases of R0 surgeries that displayed ctDNA,both patients were diagnosed with a recurrence of the disease after 6 months.In 7 patients who underwent an R1 resection,4 ctDNA positivities(4/7,57%)were detected after surgery and associated with the confirmation of early disease recurrence(after 3 to 7 months).All 15 patients(15/15,100%)undergoing R2 resection remained constantly ctDNA positive during the entire follow-up period.In 22 cases of recurrence,ctDNA positivity was detected 22 times(22/22,100%)compared to 16 positives(16/22,73%)by imaging methods and 15 cases(15/22,68%)of elevated tumor markers.CONCLUSION ctDNA detection in patients with mCRC is a viable tool for early detection of disease recurrence as well as for confirmation of the radicality of surgical treatment.

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

目的探讨基于循环肿瘤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。

Circulating tumor DNA dynamics analysis in a xenograft mouse model with esophageal squamous cell carcinoma

BACKGROUND It remains unclear which factors,such as tumor volume and tumor invasion,influence circulating tumor DNA(ctDNA),and the origin of ctDNA in liquid biopsy is always problematic.To use liquid biopsies clinically,it will be very important to address these questions.AIM To assess the origin of ctDNA,clarify the dynamics of ctDNA levels,assess ctDNA levels by using a xenograft mouse after treatment,and to determine whether tumor volume and invasion are related to ctDNA levels.METHODS Tumor xenotransplants were established by inoculating BALB/c-nu/nu mice with the TE11 cell line.Groups of mice were injected with xenografts at two or four sites and sacrificed at the appropriate time point after xenotransplantation for ctDNA analysis.Analysis of ctDNA was performed by droplet digital PCR,using the human telomerase reverse transcriptase(hTERT)gene.RESULTS Mice given two-site xenografts were sacrificed for ctDNA at week 4 and week 8.No hTERT was detected at week 4,but it was detected at week 8.However,in four-site xenograft mice,hTERT was detected both at week 4 and week 6.These experiments revealed that both tumor invasion and tumor volume were asso ciated with the detection of ctDNA.In resection experiments,hTERT was detected at resection,but had decreased by 6 h,and was no longer detected 1 and 3 d after resection.CONCLUSION We clarified the origin and dynamics of ctDNA,showing that tumor volume is an important factor.We also found that when the tumor was completely resected,ctDNA was absent after one or more days.

血浆及肿瘤组织HPV ctDNA表达水平与宫颈癌腹主动脉旁淋巴结受累、术后复发的关系

目的分析宫颈癌患者血浆及肿瘤组织中人乳头瘤病毒(HPV)循环肿瘤DNA(ctDNA)表达水平与腹主动脉旁淋巴结(PALN)受累、术后复发的关系。方法选取宫颈癌患者102例,根据患者是否合并腹主动脉旁淋巴结受累分为受累组(n=15例)和无受累组(n=87例),根据术后随访期间是否复发分为复发组(n=31例)和未复发组(n=71例),收集各宫颈癌患者的年龄、病理分级等资料。实验室检测患者血清及肿瘤组织中HPV ctDNA表达水平,比较不同组的宫颈癌患者血浆及肿瘤组织中HPV ctDNA表达水平,并分析其与PALN受累、术后复发的关系。结果宫颈癌患者血浆和癌组织HPV ctDNA表达水平与PALN受累、临床分期、分化程度、肌层浸润深度存在显著相关性(P<0.05)。复发组与未复发组在PALN受累、临床分期、分化程度、肌层浸润深度、血浆和癌组织HPV ctDNA表达水平比较存在显著差异(P<0.05)。受试者工作特征(ROC)曲线分析可知,血浆和癌组织HPV ctDNA表达诊断宫颈癌患者PALN受累的AUC分别为0.841、0.823(P<0.05),预测宫颈癌患者术后复发的AUC分别为0.759、0.735(P<0.05)。结论血浆和癌组织HPV ctDNA表达水平与宫颈癌患者PALN受累、术后复发存在显著相关性,HPV ctDNA表达水平较高的患者更易发生PALN受累和术后复发。