摘要
目的探讨循环肿瘤DNA(ctDNA)在预测局部晚期直肠癌(LARC)患者新辅助放化疗(nCRT)病理完全缓解的价值。方法选取2020-03至2021-09陆军第八十二集团军医院招募的104例LARC患者为研究对象,收集患者基线资料、nCRT期间的血浆样本进行基因测序。分析ctDNA状态和治疗反应之间的关联。评估单独ctDNA、单独MRI及将ctDNA与MRI联合使用对预测病理完全缓解(pCR)的价值;并经logistic单因素及多因素分析,影响pCR的独立临床因素。结果104例中,有35例(33.65%)患者术后达到pCR,91例(87.50%)患者基线ctDNA阳性。pCR患者中手术前ctDNA阴性比例、ctDNA清除率显著高于N-pCR患者,差异有统计学意义(P<0.05)。在pTRG3级患者中ctDNA阴性比例、ctDNA清除率显著降低(P<0.05)。经Logistic单因素及多因素分析发现,ctDNA清除、cCR是影响pCR的独立临床因素。ctDNA清除联合MRI诊断pCR曲线下面积为0.937(0.885~0.989),比ctDNA清除或MRI单独预测价值更高。结论基于MRI获得的临床完全缓解标准联合ctDNA具有预测LARC患者pCR的价值。
Objective To investigate the value of circulating tumor(ct)DNA in predicting pathological complete remission(pCR)of neoadjuvant chemoradiotherapy(nCRT)in patients with locally advanced rectal cancer(LARC).Methods A total of 104 LARC patients recruited from March 2020 to September 2021 were selected as the study objects,and the baseline data and plasma samples during nCRT were collected for gene sequencing.The association between ctDNA status and treatment response was analyzed.The value of ctDNA alone,MRI alone,and the combination of ctDNA and MRI in predictive pCR was evaluated.The independent clinical factors influencing pCR were analyzed by logistic univariate and multifactorial analysis.Results Of the 104 patients,35(33.65%)achieved pCR after surgery,and 91(87.50%)had positive ctDNA at baseline.The proportion of negative ctDNA and ctDNA clearance before surgery in patients with pCR were significantly higher than those in patients with N-pCR(P<0.05).The proportion of ctDNA negativity and ctDNA clearance in pTRG3 patients were significantly reduced(P<0.05).Logistic univariate and multivariate analysis showed that ctDNA clearance and cCR were independent clinical factors affecting pCR(P<0.05).The area under the pCR curve of ctDNA clearance combined with MRI diagnosis was 0.937(0.885-0.989),which was higher than that of ctDNA clearance or MRI alone.Conclusions The standard of clinical complete response based on MRI combined with ctDNA has the value of predicting pCR in LARC patients.
作者
赵玉红
曹伟
张磊
ZHAO Yuhong;CAO Wei;ZHANG Lei(Department of Gastroenterology,the 82nd Group Military Hospital of PLA Army,Baoding 071000,China)
出处
《武警医学》
CAS
2024年第7期607-612,共6页
Medical Journal of the Chinese People's Armed Police Force
基金
保定市科学技术局科研计划项目(18ZF181)
关键词
循环肿瘤DNA
局部晚期直肠癌
病理完全缓解
临床完全缓解
MRI
circulating tumor DNA
locally advanced rectal cancer
complete pathological remission
clinical complete remission
MRI
