血清外泌体Hsa_circ_0005019、Hsa_circ_0004390水平对宫颈癌患者术后短期预后的影响

Effects of serum levels of exosomes Hsa_circ_0005019 and Hsa_circ_0004390 on short-term postoperative prognosis in patients with cervical cancer

摘要:

目的 探讨血清外泌体Hsa_circ_0005019、Hsa_circ_0004390水平对宫颈癌患者术后短期预后的影响。方法 前瞻性选取2022年6月—2024年6月西安市红会医院行宫颈癌根治术的385例宫颈癌患者，所有患者随访1年，过程中失访5例，380例患者根据是否出现复发转移分为预后良好组和预后不良组。比较两组临床资料、血常规指标、血清外泌体Hsa_circ_0005019、Hsa_circ_0004390水平，多因素逐步Logistic回归模型分析宫颈癌短期预后的影响因素，绘制受试者工作特征曲线，分析血清外泌体Hsa_circ_0005019、Hsa_circ_0004390水平对宫颈癌短期预后的价值。Rstudio 4.2.1绘制风险预警评分模型，构建列线图模型。结果 预后良好组宫颈间质浸润深度<1/2占比、FIGO分期为ⅠA、ⅠB1占比和Hsa_circ_0005019水平均高于预后不良组（P <0.05），血清Hsa_circ_0004390水平低于预后良好组（P <0.05）。鳞状细胞癌组Hsa_circ_0005019相对表达量高于腺癌组和腺鳞癌组（P <0.05），腺癌组高于腺鳞癌组（P <0.05）；鳞状细胞癌组Hsa_circ_0004390低于腺癌组和腺鳞癌组（P <0.05），腺癌组低于腺鳞癌组（P <0.05）。多因素逐步Logistic回归分析结果显示：血清Hsa_circ_0005019水平高［O^R=0.289（95% CI：0.095，0.879）］为宫颈癌短期预后不良的保护因素（P <0.05），宫颈间质浸润深度≥1/2［O^R=3.740（95% CI：1.785，7.834）］、Hsa_circ_0004390水平高（O^R=10.166（95% CI：3.767，27.433）］和FIGO分期为ⅠB2、ⅡA［O^R=3.540（95% CI：1.696，7.389）］均为宫颈癌短期预后不良的危险因素（P <0.05）。ROC曲线分析结果显示，Hsa_circ_0005019、Hsa_circ_0004390联合检测的曲线下面积、敏感性分别为0.843（95% CI：0.802，0.878）、90.2%（95% CI：0.683，0.988）；特异性为64.6%（95% CI：0.590，0.731）。结论 宫颈癌患者血清外泌体Hsa_circ_0005019、Hsa_circ_0004390水平与术后短期预后有关，两者联合检测对于评估患者预后的价值较高。

Abstract:

Objective To explore the value of serum levels of exosomes Hsa_circ_0005019 and Hsa_circ_0004390 for predicting the short-term postoperative prognosis of patients with cervical cancer.Methods We prospectively enrolled 385 patients with cervical cancer who underwent radical surgery at our hospital from June 2022 to June 2024. All patients were followed up for one year. During the follow-up, 5 cases were lost to follow-up. The 380 patients were divided into the good prognosis group and the poor prognosis group based on whether recurrence and metastasis occurred. The clinical data, blood routine indicators, and the serum levels of exosomes Hsa_circ_0005019 and Hsa_circ_0004390 were compared between the two groups. Multivariable logistic regression was used to analyze the factors affecting the short-term postoperative prognosis of cervical cancer, and the receiver operating characteristic curve was applied to analyze the value of serum levels of exosomes Hsa_circ_0005019 and Hsa_circ_0004390 in predicting the short-term postoperative prognosis of cervical cancer. A nomogram for the risk prediction score model was constructed and plotted using RStudio 4.2.1.Results The good prognosis group had a higher proportion of patients with a depth of cervical stromal invasion < 1/2, a higher proportion of FIGO stage IA and IB1 diseases, and higher serum Hsa_circ_0005019 levels compared with the poor prognosis group (P < 0.05), whereas serum Hsa_circ_0004390 levels were lower in the poor prognosis group (P < 0.05). In the squamous cell carcinoma group, Hsa_circ_0005019 levels were higher than in the adenocarcinoma and adenosquamous carcinoma groups (P < 0.05), and they were even higher in the adenocarcinoma group than in the adenosquamous carcinoma group (P < 0.05). Conversely, Hsa_circ_0004390 levels were lower in the squamous cell carcinoma group than in the adenocarcinoma and adenosquamous carcinoma groups (P < 0.05), and they were even lower in the adenocarcinoma group than in the adenosquamous carcinoma group (P < 0.05). Multivariable stepwise logistic regression analysis showed that high serum Hsa_circ_0005019 levels [O^R = 0.289 (95% CI: 0.095, 0.879) ] were a protective factor against poor prognosis (P < 0.05), whereas the depth of cervical stromal invasion ≥1/2 [O^R = 3.740 (95% CI: 1.785, 7.834) ], high Hsa_circ_0004390 levels [O^R = 10.166 (95% CI: 3.767, 27.433) ], and FIGO stage IB2 or IIA diseases [O^R = 3.540 (95% CI: 1.696, 7.389) ] were independent risk factors for short-term poor prognosis in cervical cancer (P < 0.05). ROC curve analysis indicated that combined detection of Hsa_circ_0005019 and Hsa_circ_0004390 yielded the highest area under the curve and sensitivity, at 0.843 (95% CI: 0.802, 0.878) and 90.2% (95% CI: 0.683, 0.988), respectively, while specificity was the lowest at 64.6% (95% CI: 0.590, 0.731).Conclusion The serum levels of exosomes Hsa_circ_0005019 and Hsa_circ_0004390 are associated with short-term postoperative prognosis in patients with cervical cancer, and their combined assessment provides greater value in predicting patient outcomes.