三维能量多普勒超声及血清FGFR4、Spondin-2对宫颈癌化疗疗效的评估价值

Evaluation value of three-dimensional power Doppler ultrasound in treatment of cervical cancer with PF and its correlation with serum FGFR4 and Spondin-2

摘要:

目的 探讨三维能量多普勒超声（3D-PDU）及血清成纤维细胞生长因子受体4（FGFR4）、Spondin-2对顺铂联合氟尿嘧啶（PF）治疗宫颈癌的疗效评估价值。方法 回顾性分析2017年7月—2019年7月攀枝花市妇幼保健院收治的98例宫颈癌患者临床资料，均采取PF治疗，根据化疗疗效分为有效组60例和无效组38例。比较有效组和无效组化疗前后3D-PDU参数［血管形成指数（VI）、血管形成-血流指数（VFI）、血流指数（FI）］、血清FGFR4、Spondin-2水平。Pearson法分析化疗前3D-PDU参数与血清FGFR4、Spondin-2水平的相关性。绘制受试者工作特征（ROC）曲线，分析化疗前3D-PDU参数及血清指标对化疗有效性的预测效能。结果 ①3D-PDU参数：化疗前两组FI、VFI、VI差异无统计学意义（P >0.05），化疗后两组FI、VFI、VI均较化疗前降低（P <0.05），化疗后有效组FI、VFI、VI低于无效组（P <0.05）；②血清FGFR4、Spondin-2水平：化疗前两组血清FGFR4、Spondin-2水平差异无统计学意义（P >0.05），化疗后两组血清FGFR4、Spondin-2水平均较化疗前降低（P <0.05），化疗后有效组血清FGFR4、Spondin-2水平低于无效组（P <0.05）；③相关性分析：化疗前PF治疗宫颈癌有效患者的VI、VFI、FI与血清FGFR4、Spondin-2水平呈正相关；④预测效能：ROC曲线显示化疗前联合预测宫颈癌化疗疗效的AUC最大，为0.854（95% CI：0.769，0.918），诊断敏感性和特异性分别为86.67%（95% CI：0.748 6，0.936 6）、76.32%（95% CI：0.593 9，0.879 7），其次为FGFR4 0.811（95% CI：0.719，0.883）、VFI 0.783（95% CI：0.688，0.860）、Spondin-2 0.782（95% CI：0.687，0.859）、FI 0.773（95% CI：0.677，0.851）、VI 0.758（95% CI：0.661，0.839）。结论 化疗前宫颈癌3D-PDU参数与血清FGFR4、Spondin-2水平呈正相关，联合检测有助于预测化疗效果，为临床优化宫颈癌个体化治疗提供理论依据。

Abstract:

Objective To investigate the value of three-dimensional power Doppler ultrasound (3D-PDU) in the treatment of cervical cancer with PF and its correlation with serum fibroblast growth factor receptor 4 (FGFR4) and Spondin-2.Methods The clinical data of 98 cervical cancer patients admitted to our hospital from July 2017 to July 2019 were retrospectively analyzed, all of whom were treated with PF, and were divided into an effective group (n = 60) and an ineffective group (n = 38) according to the efficacy of chemotherapy. Statistical comparison of 3D-PDU parameters [vascular formation index (VI), vascularization-blood flow index (VFI), blood flow index (FI)], serum FGFR4, Spondin-2 levels before and after chemotherapy in the effective and ineffective groups. Pearson was used to analyze the correlation between the 3D-PDU parameters and serum FGFR4 and Spondin-2 levels before chemotherapy, and to draw the receiver operating curve (ROC), and analyze the predictive efficacy of 3D-PDU parameters and serum indexes before chemotherapy on the effectiveness of chemotherapy.Results 3D-PDU parameters: There was no significant difference in FI, VFI, and VI between the two groups before chemotherapy (P >0.05). After chemotherapy, FI, VFI, and VI in both groups were lower than before chemotherapy (P < 0.05); the FI, VFI, and VI of the effective group were lower than those of the ineffective group (P < 0.05); serum FGFR4 and Spondin-2 levels: There was no significant difference in serum FGFR4 and Spondin-2 levels before chemotherapy (P > 0.05). After chemotherapy, the levels of FGFR4 and Spondin-2 in the two groups were lower than before chemotherapy (P < 0.05), and the levels of serum FGFR4 and Spondin-2 in the effective group were lower than those in the ineffective group (P < 0.05); Correlation analysis: FI, VFI, and VI of patients with cervical cancer PF treatment before chemotherapy were positively correlated with serum FGFR4 and Spondin-2 levels; Predictive efficacy: The ROC curve showed that the combined predictive value of cervical cancer chemotherapy before chemotherapy was the largest AUC value, which was 0.854 (95% CI: 0.769, 0.918), and the diagnostic sensitivity and specificity were 86.67% (95% CI: 74.86%, 93.66%） and 76.32% (95% CI: 59.39%, 87.97%）, followed by FGFR4 [0.811 (95% CI: 0.719, 0.883)], VFI [0.783 (95% CI: 0.688, 0.860)], Spondin-2 [0.782 (95% CI: 0.687, 0.859)], FI [0.773 (95% CI: 0.677, 0.851)], and VI [0.758 (95% CI: 0.661, 0.839)].Conclusion The 3D-PDU parameters of cervical cancer before chemotherapy are positively correlated with serum FGFR4 and Spondin-2 levels. Joint detection can help predict the effect of chemotherapy and provide a theoretical basis for the clinical optimization of individualized cervical cancer treatment.