Prediction of advanced cervical cancer patients recurrence risk by a nematogram model based on peripheral blood circulating tumor cells and circulating tumor DNA

XIE Kongying; ZHU Jia; PENG Wenjuan; WU Hai

doi:10.3969/j.issn.1009-0460.2025.02.010

Abstract：Objective Based on peripheral blood circulating tumor cells(CTCs)and circulating tumor DNA(ctDNA),a nomogram model was constructed to predict the recurrence risk of advanced cervical cancer patients.Methods A total of 360 patients with advanced cervical cancer who received treatment in Leshan Maternal and Child Health Hospital,from June 2017 to June 2022 were selected.The patients were followed up for 2 years and divided into recurrence group and non-recurrence group according to the recurrence situation.The clinical data of the two groups were compared,and the risk factors leading to recurrence of advanced cervical cancer patients were analyzed by multivariate Logistic regression model.A nomogram model was constructed,and calibration curve,Hosmer-Lemeshow test and receiver operating characteristic(ROC)curve were used to verify the efficiency of the model.In addition,ROC curve was used to evaluate the value of peripheral blood CTCs and ctDNA in predicting the recurrence risk of advanced cervical cancer patients.Results Of 360 patients with advanced cervical cancer,67(18.61％)recurred within 2 years of follow-up.There were significant differences in differentiation degree,tumor diameter,pelvic lymph node metastasis,vascular cancer thrombe,interstitial infiltration degree,CD4+/CD8+,D-D,CTCs and ctDNA between the recurrence group and the non-recurrence group(P＜0.05).Multivariate Logistic regression analysis showed that differentiation degree,tumor diameter,pelvic lymph node metastasis,CD4+/CD8+,CTCs and ctDNA were all independent factors leading to recurrence of advanced cervical cancer(P＜0.05).The nomogram model showed that CTCs was the strongest predictor of recurrence risk in patients with advanced cervical cancer,followed by pelvic lymph node metastasis,degree of differentiation,ctDNA,CD4+/CD8+,and tumor diameter.The calibration curve shows that there was a good prediction accuracy between the actual recurrence of advanced cervical cancer patients and the prediction probability.Hosmer-Lemeshow test showed that there was no statistically significant difference between the predicted value and the true value of the nomogram model(P＞0.05),indicating that the model had a good fit and high prediction accuracy.ROC curve showed that the area under the curve(AUC)of the nomogram model to predict the recurrence risk of advanced cervical cancer patients was 0.809(95％CI:0.758-0.860),the sensitivity was 0.861,the specificity was 0.742,and the Yoden index was 0.603,suggesting that the nomogram model was moderately distinguished and had good predictive efficacy.ROC curve showed that the AUC of CTCs was 0.830 and that of ctDNA was 0.817,and the combined detection was higher than that of single detection,indicating that the combined detection of CTCs and ctDNA in peripheral blood could be used as an effective indicator to predict the recurrence risk of advanced cervical cancer patients.Conclusion Differentiation degree,tumor diameter,pelvic lymph node metastasis,CD4+/CD8+,CTCs and ctDNA were all independent factors leading to recurrence of advanced cervical cancer.In addition,the nomogram model based on peripheral blood CTCs and ctDNA is effective in predicting the recurrence risk of advanced cervical cancer patients.