晚期非小细胞肺癌患者血浆cfDNA浓度与化疗有效性及生存预后的相关性研究

doi:10.3969/j.issn.2095-1264.2023.02.14

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晚期非小细胞肺癌患者血浆cfDNA浓度与化疗有效性及生存预后的相关性研究
DOI:
                        10.3969/j.issn.2095-1264.2023.02.14
                    
作者:
                        
                        
                    
作者单位:四川绵阳四0四医院 肿瘤科，四川 绵阳，621000
作者简介:邓成凤，女，主治医师，研究方向：晚期肺癌化疗、靶向治疗。
通讯作者:
中图分类号:R734.2
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Study on the relationship of the plasma cfDNA levels with the efficacy of chemotherapy and the prognosis of patients with advanced non-small cell lung cancer

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Affiliation:

Department of Oncology, Sichuan Mianyang 404 Hospital, Mianyang, 621000, Sichuan, China

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摘要:

目的探究血浆游离DNA（cfDNA）水平与晚期非小细胞肺癌（NSCLC）患者化疗有效性及生存预后的关系。方法选取本院2015年1月—2018年1月诊治的148例晚期NSCLC患者进行研究，所有患者均接受化疗，根据临床化疗效果将其分为有效组（40例）和无效组（108例）。分析患者一般资料构成及其与化疗疗效的关系；比较不同疗效患者的血浆cfDNA水平；分析化疗前血浆cfDNA水平与患者临床特征的关系；采用Kaplan-Meier生存曲线分析血浆cfDNA水平与患者预后的关系；采用COX回归分析晚期NSCLC患者预后的影响因素。结果无吸烟史晚期NSCLC患者化疗效果高于有吸烟史晚期NSCLC患者（P<0.05）。化疗后，148例晚期NSCLC患者化疗有效率为27.03%（40/148）。化疗后，有效组患者血浆cfDNA水平明显低于化疗前及无效组患者（P<0.05）；化疗前血浆cfDNA水平与晚期NSCLC患者吸烟史、肿瘤大小、淋巴结转移相关（P<0.05）。血浆cfDNA水平<0.23 ng·μL^-1组患者化疗后24个月的生存率明显高于血浆cfDNA水平≥0.23 ng·μL^-1组（P<0.05）；血浆cfDNA水平是晚期NSCLC化疗患者预后的独立影响因素（P<0.05）。结论血浆cfDNA有望成为评估晚期NSCLC患者化疗疗效及预后的有效参考指标。

Abstract:

Objective To investigate the relationship of the plasma cell-free DNA (cfDNA) levels with the efficacy of chemotherapy and the prognosis of patients with advanced non-small cell lung cancer (NSCLC).Methods Between January 2015 and January 2018, 148 patients with advanced NSCLC treated in our hospital were selected for the study. All the patients were treated with chemotherapy, and the chemotherapy efficacy of all patients were recorded. According to the clinical chemotherapy effect, the patients were divided into effective group (40 cases) and ineffective group (108 cases). The relationship between the general data and chemotherapy efficacy in patients with advanced NSCLC was analyzed. The plasma cfDNA levels of patients were compared between groups with different curative effects. The relationship between the plasma cfDNA levels before chemotherapy and the clinical characteristics of patients with advanced NSCLC was analyzed. Kaplan-Meier survival curve was used to analyze the relationship between the plasma cfDNA levels and the prognosis of patients with advanced NSCLC. COX regression was used to analyze the prognostic factors of patients with advanced NSCLC.Results The chemotherapy effect of advanced NSCLC patients without smoking history was better than that of advanced NSCLC patients with smoking history (P<0.05). After chemotherapy, the effective rate of 148 patients with advanced NSCLC was 27.03% (40/148). And the level of cfDNA in the effective group was significantly lower than that before chemotherapy and that in the ineffective group after chemotherapy (P<0.05). The level of cfDNA before chemotherapy was correlated with smoking history, tumor size and lymph node metastasis in patients with advanced NSCLC (P<0.05). The 24-month survival rate in the group with plasma cfDNA level <0.23 ng?μL^-1 was significantly higher than that in the group with plasma cfDNA level ≥0.23 ng?μL^-1 (P<0.05). The cfDNA level was an independent prognostic factor in patients with advanced NSCLC after chemotherapy (P<0.05).Conclusion Plasma cfDNA is expected to be an effective reference index for the evaluation of chemotherapy efficacy and prognosis in patients with advanced NSCLC.