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| 不同治疗时间点血脂参数在局晚期食管鳞癌患者中的预后意义 |
| Prognostic significance of blood lipid parameters at different treatment time points in patients with locally advanced esophageal squamous cell carcinoma |
| 投稿时间：2025-03-05 修订日期：2025-06-04 |
| DOI： |
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| 中文关键词: 食管鳞癌细胞 放化疗 列线图 脂质标记物 生存预后 |
| 英文关键词:Esophageal squamous cell carcinoma Chemo-radiotherapy Nomogram Lipid biomarker OS prognosis |
| 基金项目:国家卫生健康委科学研究基金—浙江省卫生健康重大科技计划项目(委省共建项目)(WKJ-ZJ2559), 浙江省自然科学基金自筹经费项目(ZCLMS25H1604), 台州市抗癌协会肿瘤专项科研项目(TACA2025-A01). |
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| 中文摘要: |
| 【】 目的 探讨不同时间点血脂水平在接受放化疗的局部晚期食管鳞状细胞癌(Esophageal squamous cell carcinoma, ESCC)患者中的作用。材料和方法 最终纳入分析152例接受了新辅助放化疗(Neoadjuvant chemo-radiotherapy,nCRT)联合手术或根治性放化疗(Definitive chemo-radiotherapy, dCRT)治疗的局部晚期ESCC患者的临床特征和血脂参数(包括TC、TG、HDL-C、LDL-C、Apo A-I、Apo B和LP(α)等)。Cox回归分析用于确定预测无进展生存期( Progression-free survival,PFS)和总生存期(Overall survival,OS)的风险因素。然后建立预测OS的列线图,并比较不同列线图的预测能力。最后,我们通过内部抽样验证评估了列线图的稳定性,并比较了列线图在ESCC患者亚组之间的预测效能。结果 放化疗期间,所有血脂参数均显著降低(均P<0.05)。治疗后的TG是PFS的预后因素(P<0.05)。治疗后TC、治疗前/后TG、HDL-C、Apo A-I、治疗前Apo B和Apo B/Apo A-I均为OS的预后因素(均P<0.05)。根据多因素进一步筛选出独立预后因素,分别构建基于治疗前/治疗后/治疗期间的血脂参数以及性别的3个列线图,其中治疗前列线图具有最佳的预测能力。3个列线图的c指数均在0.600以上,内部验证证明所有列线图都具有良好的稳定性。此外,在总人群、nCRT+手术队列和dCRT队列中,治疗前列线图的AUC均高于0.700。结论 我们发现,治疗前/中/后TG和Apo A-I是接受放化疗的ESCC患者的关键预后因素,纳入性别、治疗前TG和Apo A-I的治疗前列线图预测效率优于治疗期间以及治疗后列线图。 |
| 英文摘要: |
| 【】 Purpose To explore the role of serum lipids levels of different time points in patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing chemo-radiotherapy. Materials and Methods The clinical characteristics and serum lipid profiles parameters (such as TC, TG, HDL-C, LDL-C, Apo A-I, Apo B, and LP(α)) were collected and analyzed from 152 patients with locally advanced ESCC who were treated with neoadjuvant chemoradiotherapy (nCRT) combined with surgery or definitive chemoradiotherapy(dCRT. The Cox regression analysis were used to determine the predictive factors of progression-free survival (PFS) and overall survival (OS). Then nomograms were established to predict OS and their predictive powers were compared. Finally, we evaluated the stability of the nomograms by internal sampling validation, and made comparison in predictive powers of models between subgroups of ESCC patients. Results All serum lipid parameters were significantly decreased during chemo-radiotherapy (all P < 0.05). And, the post-TG was the prognostic factor of PFS (P < 0.05). The post-TC, pre/post-TG, HDL-C, Apo A-I, pre-Apo B, and Apo B/Apo A-I were all the prognostic factors of OS (all P < 0.05). Three nomograms were established based on lipid paraments of pre/post/dur-treatment according to the multivariate analysis and the pre-treatment nomogram had the best predictive power. The c-indexes of the nomograms were all above 0.600. Finally, internal validation proved that the nomograms were all have good stability. The AUC of pre-treatment nomogram in total population, nCRT+surgery cohort, and dCRT cohort were all above 0.700.? Conclusion We found that pre-/dur-/post TG and Apo A-I were crucial prognostic factors for ESCC patients treated with chemo-radiotherapy, and the predictive efficiency of pre-treatment nomogram enrolled gender, pre-TG, and pe-Apo A-I was superior to dur- and post-treatment nomogram. |
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