| 王 苗,孙雪烽,金芷呈,等.不同治疗时间点血脂参数在局晚期食管鳞癌患者预后中的意义[J].肿瘤学杂志,2025,31(9):801-811. |
| 不同治疗时间点血脂参数在局晚期食管鳞癌患者预后中的意义 |
| Association Between Blood Lipid Levels at Different Time-Points and Prognosis of Patients with Locally Advanced Esophageal Squamous Cell Carcinoma |
| 投稿时间：2025-03-05 |
| DOI：10.11735/j.issn.1671-170X.2025.09.B008 |
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| 中文关键词: 食管肿瘤 鳞状细胞癌 血脂 放化疗 预后 列线图 |
| 英文关键词:esophageal neoplasms squamous cell carcinoma blood lipid chemoradiotherapy prognosis Nomogram |
| 基金项目:浙江省卫生健康重大科技计划项目 （WKJ-ZJ2559）；浙江省自然科学基金（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: |
| 摘 要：［目的］ 探讨不同时间点血脂水平在放化疗的局晚期食管鳞状细胞癌（esophageal squamous cell carcinoma，ESCC）患者预后预测中的作用。［方法］ 纳入分析152例新辅助放化疗联合手术或根治性放化疗治疗的局晚期ESCC患者的临床特征和血脂参数，包括总胆固醇（total cholesterol，TC）、甘油三酯（triglycerides，TG）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）、载脂蛋白A-I（apolipoprotein A-I，Apo A-I）、载脂蛋白B（apolipoprotein B，Apo B）和脂蛋白（α）［lipoprotein （α），LP（α）］。Cox比例风险回归分析用于分析无进展生存期（progression-free survival，PFS）和总生存期（overall survival，OS）的影响因素，建立预测OS的列线图，并比较不同预测模型的预测能力。［结果］ 放化疗期间，局晚期ESCC患者血脂参数均显著降低（P均<0.05）。在放化疗前pre-CRT模型中，性别（HR=2.206，P=0.022）、治疗前TG（HR=0.207，P＜0.001）和治疗前Apo A-I（HR=0.218，P=0.001）是OS的独立预测因素。在放化疗期间dur-CRT模型中，性别（HR=2.340，P=0.013）和Apo A-I最小值（HR=0.439，P=0.013）是OS的独立预测因素。在放化疗后post-CRT模型中，性别（HR=2.043，P=0.039）、治疗后TG（HR=0.421，P=0.019）和治疗后Apo A-I（HR=0.373，P＜0.001）是OS的独立预测因素。 根据多因素Cox回归分析筛选出OS的独立预后因素分别构建基于放化疗前/放化疗期间/放化疗后血脂参数的3个预测模型列线图，其中放化疗前模型（pre-CRT模型）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。在局晚期ESCC患者总人群、nCRT+手术患者和dCRT患者中，pre-CRT模型列线图预测1年生存率的受试者工作特征曲线下面积值均高于0.700。［结论］ 放化疗前、放化疗期间和放化疗后TG和Apo A-I水平是放化疗局晚期ESCC患者的预后因素。基于临床特征及放化疗前血脂参数构建的模型预测能力较优。 |
| 英文摘要: |
| Abstract： ［Objective］ To explore the association between serum lipids levels at different time points and the prognosis of patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing chemoradiotherapy. ［Methods］ The clinical data of 152 patients with locally advanced ESCC who received surgical treatment and neoadjuvant chemoradiotherapy (nCRT) or definitive chemoradiotherapy (dCRT) were retrospectively analyzed. The lipid profiles before， during and after chemoradiotherapy were documented， including serum total cholesterol (TC)， triglycerides (TG)， high-density lipoprotein cholesterol (HDL-C)， low-density lipoprotein cholesterol (LDL-C)， apolipoprotein A-I (Apo A-I) ， apolipoprotein B (Apo B) and lipoprotein (α) ［LP(α)］. The Cox regression analysis was used to determine the predictive factors of progression-free survival (PFS) and overall survival (OS). The prediction Nomograms based on pre-during and post chemoradiotherapy lipid parameters were developed (pre-CRT， dur-CRT and post-CRT models) and their predictive powers were evaluated. ［Results］ All serum lipid parameters were significantly decreased during chemoradiotherapy (all P<0.05). In the pre-CRT model， sex (HR=2.206， P=0.022)， pre-TG (HR=0.207， P<0.001)， and pre-Apo A-I (HR=0.218， P=0.001) were independent predictors of OS. In dur-CRT model， sex (HR=2.340， P=0.013) and the dur-Apo A-Imin (HR=0.439， P=0.013) were independent predictors of OS. In post-CRT model， sex (HR=2.043， P=0.039)， post-TG (HR=0.421， P=0.019)， and post-Apo A-I (HR=0.373， P<0.001) were independent predictors of OS. The C-indexes of the Nomograms were all above 0.600， while the pre-CRT model for predicting survival had the best predictive power. The area under curve of pre-CRT model for predicting 1-year survival in total population， nCRT+surgery population， and dCRT population were all above 0.700. ［Conclusion］ Pre-/dur-/post TG and Apo A-I are prognostic factors for locally advanced ESCC patients treated with chemoradiotherapy. The predictive ability of the model developed based on clinical features and lipid parameters before treatment is the best. |
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