作者：胡婷婷，鲁洪岭，刘倩，孙云川

单位：

河北省沧州中西医结合医院放疗科

单位（英文）：

Radiotherapy Department, Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou 061000, China

关键词：

癌,非小细胞肺; 双能量CT; Krüppel样因子5; 可溶性T细胞免疫球蛋白黏蛋白分子3; 预后;

关键词（英文）：

Cancer, non-small cell lung; Dual-energy CT; KLF5; sTIM-3; Prognosis

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2023.00.183

基金项目：

摘要：

目的 探讨双能量CT(DECT)碘图定量参数和血清Krüppel样因子5(KLF5)、可溶性T细胞免疫球蛋白黏蛋白分子3(sTIM-3)与晚期非小细胞肺癌（NSCLC）患者预后的关系。方法 选取2019年6月至2020年3月河北省沧州中西医结合医院收治的125例晚期NSCLC患者为研究对象，根据患者出院后2年生存情况将其分为存活组（n=37）和死亡组（n=88）。比较两组临床资料、DECT碘图定量参数和血清KLF5、sTIM-3。所有患者通过电话随访2年，每3个月随访1次，终点事件为死亡，随访截止时间为2022年3月。晚期NSCLC患者预后的影响因素分析采用多因素Cox比例风险回归分析，绘制ROC曲线以评价DECT碘图定量参数和血清KLF5、sTIM-3及其联合对晚期NSCLC患者预后的预测价值。结果 两组TNM分期、分化程度和有淋巴结转移、远处转移、骨转移者占比及美国东部肿瘤协作组（ECOG）评分、治疗线数比较，差异有统计学意义（P<0.05）。死亡组病变内碘浓度（IC）、标准化碘浓度（NIC）、能谱曲线斜率（λ）及血清KLF5、sTIM-3均高于存活组（P<0.05）。多因素Cox比例风险回归分析结果显示，TNM分期、分化程度、淋巴结转移、远处转移、骨转移、ECOG评分、病变内IC、NIC、λ及血清KLF5、sTIM-3均是晚期NSCLC患者预后的影响因素（P<0.05）。ROC曲线分析结果显示，DECT碘图定量参数联合血清KLF5、sTIM-3预测晚期NSCLC患者预后的AUC为0.981，分别高于DECT碘图定量参数、血清KLF5、血清sTIM-3单独预测晚期NSCLC患者预后的AUC(P<0.05)。结论 DECT碘图定量参数（病变内IC、NIC、λ）和血清KLF5、sTIM-3升高均是晚期NSCLC患者预后不良的危险因素，且五者联合预测晚期NSCLC患者预后的AUC为0.981，预测价值较高。

英文摘要：

Objective To investigate the relationship between dual-energy CT (DECT) iodine quantitative parameters, serum Krüppel-like factor 5 (KLF5) and solubility T cell immunoglobulin-and mucin-domain-containing molecule-3 (sTIM-3) and prognosis of patients with advanced non-small cell lung cancer (NSCLC) . Methods A total of 125 patients with advanced NSCLC admitted to Cangzhou Hospital of Integrated TCM-WM·Hebei from June 2019 to March 2020 were selected as the research objects. According to the 2-year survival after discharge, the patients were divided into survival group (n=37) and death group (n=88) . The clinical data, DECT iodine quantitative parameters and serum KLF5 and sTIM-3 were compared between the two groups. All patients were followed up by telephone for 2 years, once every 3 months. The endpoint event was death, and the follow-up deadline was March 2022. Multivariate Cox proportional hazard regression analysis was used to analyze the prognostic factors of patients with advanced NSCLC. ROC curve was drawn to evaluate the predictive value of DECT iodine quantitative parameters and serum KLF5 and sTIM-3 and their combination on the prognosis of patients with advanced NSCLC. Results There were significant differences in TNM stage, degree of differentiation, proportion of patients with lymph node metastasis, distant metastasis and bone metastasis, Eastern Cooperative Oncology Group (ECOG) score and number of treatment lines between the two groups (P < 0.05) . The iodine concentration (IC) in the lesion, normalized iodine concentration (NIC) , energy spectrum curve slope (λ) , serum KLF5 and sTIM-3 in the death group were higher than those in the survival group (P < 0.05) . Multivariate Cox proportional hazard regression analysis showed that TNM stage, differentiation degree, lymph node metastasis, distant metastasis, bone metastasis, ECOG score, IC in the lesion, NIC, λ, serum KLF5 and sTIM-3 were prognostic factors in patients with advanced NSCLC (P < 0.05) . ROC curve analysis showed that the AUC of DECT iodine quantitative parameters combined with serum KLF5 and sTIM-3 in predicting the prognosis of patients with advanced NSCLC was 0.981, which was higher than that of DECT iodine quantitative parameters, serum KLF5 and serum sTIM-3 alone in predicting the prognosis of patients with advanced NSCLC (P < 0.05) . Conclusion The increase of DECT iodine quantitative parameters (IC in the lesion, NIC, λ) and serum KLF5 and sTIM-3 were risk factors for poor prognosis in patients with advanced NSCLC, and the AUC of the five combined to predict the prognosis of patients with advanced NSCLC was 0.981, with high predictive value.

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