目的 探讨血清趋化因子配体20(CCL20)、叉头框D1(FOXD1)对宫颈癌患者放化疗后复发、转移的预测价值。方法 选取河北省沧州中西医结合医院2021年3月至2024年2月进行放化疗后的宫颈癌患者134例作为研究组,根据患者是否复发、转移将其分为复发组(n=38)、未复发组(n=96),选取同期130例宫颈良性病变患者(病变组)和100例健康体检者(对照组)进行比较。采用ELISA法检测血清CCL20、FOXD1表达水平,并比较复发组与未复发组临床病理特征及血清CCL20、FOXD1表达水平;采用多因素Logistic回归分析放化疗后宫颈癌患者复发、转移的影响因素,受试者操作特征(ROC)曲线评估血清CCL20、FOXD1的预测价值;决策曲线分析(DCA)预测模型的临床价值。结果 血清CCL20和FOXD1水平呈梯度升高(研究组＞病变组＞对照组,P＜0.05)。复发组肿瘤分期Ⅳ期、有淋巴结转移、浸润深度≥1/2占比及血清CCL20、FOXD1水平均高于未复发组(P＜0.05)。这些因素均是放化疗后宫颈癌患者复发、转移的独立危险因素(P＜0.05)。血清CCL20、FOXD1及联合预测宫颈癌患者放化疗后复发、转移的曲线下面积(AUC)分别为0.844、0.859及0.936,优于各自单独预测(Z联合-CCL20=2.887、Z联合-FOXD1=2.241,P=0.004、P=0.025)。DCA结果显示,当阈值概率范围为0.04~0.98时,血清CCL20、FOXD1联合预测宫颈癌患者放化疗后复发、转移的净获益率高于单一指标预测。结论 宫颈癌患者血清CCL20、FOXD1表达水平均明显升高,二者联合检测对宫颈癌患者放化疗后复发、转移可能有更高的临床预测价值。
Abstract
Objective To explore the predictive value of serum chemokine ligand 20 (CCL20) and forkhead box D1 (FOXD1) for relapse and metastasis in cervical cancer patients after radiotherapy and chemotherapy. Method From March 2021 to February 2024, 134 patients with cervical cancer who underwent radiotherapy and chemotherapy in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province were designated as the study group. They were grouped into a relapse group (n=38) and a non-relapsing group (n=96) based on whether they had relapse or metastasis. Meanwhile, 130 patients with benign cervical lesions were served as the lesion group. Another 100 healthy individuals who underwent physical examination were served as the control group. ELISA method was used to detect serum CCL20 and FOXD1. The clinical pathological features, as well as serum CCL20 and FOXD1, were compared between the relapse and non-relapsing groups. Multivariate logistic regression was used to explore the influencing factors of relapse and metastasis in cervical cancer patients after radiotherapy and chemotherapy. ROC curve was used to explore the predictive value of serum CCL20 and FOXD1 for relapse and metastasis in cervical cancer patients after radiotherapy and chemotherapy. Decision curve (DCA) analysis for predicting the clinical value of the model. Result Serum CCL20 and FOXD1 levels showed a gradient increase (study group> lesion group> control group, P<0.05). The relapse group had higher proportions of tumor stage Ⅳ, lymph node metastasis, infiltration depth ≥1/2, and levels of serum CCL20 and FOXD1 than the non-relapse group (P<0.05). All these factors were independent risk factors for recurrence and metastasis after chemoradiotherapy (P<0.05). The area under the curve (AUC) values of serum CCL20, FOXD1, and their combination in predicting relapse and metastasis in cervical cancer patients after radiotherapy and chemotherapy were 0.844, 0.859, and 0.936, respectively. The combination was better than the individual predictions (Z combination - CCL20=2.887, Z combination - FOXD1=2.241, P=0.004, P=0.025). The results of DCA curve analysis showed that when the high-risk threshold was 0.04 to 0.98, the net benefit rate of the combined prediction of serum CCL20 and FOXD1 for recurrence and metastasis of cervical cancer patients after radiotherapy and chemotherapy was higher than that predicted by a single indicator. Conclusion The expression levels of CCL20 and FOXD1 in the serum of cervical cancer patients were significantly elevated, and the combined detection may have higher predictive value for recurrence and metastasis after chemoradiotherapy in cervical cancer patients.
关键词
宫颈癌 /
趋化因子配体20 /
叉头框D1 /
放化疗 /
复发 /
转移 /
预测价值 /
预后
Key words
Cervical cancer /
Chemokine ligand 20 /
Forkhead box D1 /
Radiotherapy and chemotherapy /
Relapse /
Metastasis /
Measurement value /
Prognosis
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