血清 TSGF、MCP-1、Ang-2 与腹腔镜下子宫肌瘤剔除术后复发的关系 及列线图预测模型构建.

Objective: To explore the relationship between serum tumor specific growth factor (TSGF), monocyte chemoattractant protein-1 (MCP-1), angiopoietin-2 (Ang-2) and recurrence after laparoscopic myomectomy (LM) and the construction of a nomograph prediction model. Methods: 213 uterine fibroids patients who were undergoing LM surgery admitted to our hospital from June 2018 to June 2020 were selected as study subjects. The serum levels of TSGF, MCP-1 and Ang-2 were detected in all patients. After 3 years of follow-up, patients were divided into recurrence group and non-recurrence group according to whether patients had recurred 3 years after operation, the serum levels of TSGF, MCP-1 and Ang-2 were compared between two groups. The risk factors of recurrence after LM in uterine fibroids patients were analyzed by univariate and multivariate Logistic regression analysis, and a nomograph prediction model for postoperative recurrence risk was constructed according to the risk factors. The predictive efficacy of serum MCP-1, TSGF and Ang-2 on the recurrence of LM in uterine fibroids patients were analyzed by receiver operating characteristic (ROC) curve. Results: 213 uterine fibroids patients were followed up for 3 years, and 8 patients were lost to follow-up, there were 37 cases of recurrence in 205 uterine fibroids patients 3 years after LM, and the recurrence rate was 18.05% (37/205). The serum levels of Ang-2, MCP-1 and TSGF in non-recurrence group were lower than those in recurrence group, and the differences were statistically significant(P<0.05). Multivariate Logistic regression analysis showed that, postoperative residual myoma, elevated serum TSGF, age≥35 years, elevated MCP-1, multiple fibroids and elevated Ang-2 were independent risk factors for recurrence after LM in uterine fibroids patients(P<0.05). ROC analysis showed that, the area under the curve (AUC) of serum TSGF, MCP-1, Ang-2 and nomograph prediction model was 0.873 (95%CI: 0.801~0.944), 0.721 (95%CI: 0.624~0.817), 0.803 (95%CI: 0.722~0.885), 0.986 (95%CI: 0.973~0.998). Internal validation (B=1000) showed that, the C-index was 0.972, suggesting that the nomograph prediction model had a good predictive ability. The decision analysis shows that, the threshold probability of the model was 0.01~0.95, and the net return rate was>0, which was higher than the two invalid lines. Conclusion: The increase of serum TSGF, MCP-1 and Ang-2 levels can lead to the recurrence of LM in uterine fibroids patients. Age≥35 years old, multiple fibroids, postoperative residual myoma, elevated serum TSGF, elevated MCP-1 and elevated Ang-2 are independent risk factors for recurrence after LM in uterine fibroids patients. The nomograph prediction model base on independent risk factors has a good predictive value for the recurrence of LM in uterine fibroids patients. [ABSTRACT FROM AUTHOR]