福建宁德宁德师范学院附属宁德市医院胸心外科;
目的 探讨血循环肿瘤DNA(ctDNA)-微小残留病灶(MRD)预测NSCLC术后早期复发风险和辅助化疗疗效的效能。方法 收集2020年1月至2022年12月在宁德师范学院附属宁德市医院接受手术的102例非小细胞肺癌(NSCLC)患者为研究对象。术前、术后(术后4周内和辅助治疗开始前)、辅助治疗后以及后续纵向监测期间(每3个月一次),采用二代测序(NGS)技术检测ctDNA-MRD情况。随访患者的无复发生存期(RFS)。结果 92例患者肿瘤组织检测到体细胞突变，其中83.70%(77/92)术前血浆样本中检测到突变。患者中位随访时间为388天(范围：123～592天),复发率30.43%(28/92)。多因素Cox风险比例回归模型结果显示，术后ctDNA-MRD是影响NSCLC术后RFS的独立因素(P<0.05)。与术后ctDNA-MRD阴性患者比较，术后ctDNA-MRD阳性患者的复发率更高(68.0%vs. 16.42%),中位RFS更短(311天vs. 401天，P<0.05)。Kaplan-Meier结果显示，接受辅助治疗的ctDNA-MRD阳性患者的中位RFS时间显著长于未接受辅助治疗者(352天vs. 140天，P=0.027)。在影像学证实复发的28例患者中，24例患者纵向ctDNA-MRD呈阳性。ctDNA-MRD阳性先于影像学复发，中位领先时间为158天。纵向ctDNA-MRD阳性患者中位RFS时间显著短于阴性患者322天vs. 422天(P<0.05)。结论 血ctDNA-MRD阳性与NSCLC的RFS有关。术后ctDNA-MRD阳性的患者接受辅助治疗后更可能获益。血ctDNA-MRD可能作为NSCLC术后早期复发风险分层以及辅助治疗决策的有用生物标志物。
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基本信息:
DOI：
中图分类号:R734.2
引用信息:
[1]叶辉,许涛,杨莺等.血ctDNA-MRD监测对预测NSCLC术后早期复发风险和辅助治疗疗效的临床观察[J].临床肿瘤学杂志,2025,30(03):233-238.
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