血清γ-组蛋白H2AX联合可溶性凋亡相关因子与配体比值对鼻咽癌放疗预后的预测价值OA

OBJECTIVE To analyze the characteristics of serum gamma-histone H2AX(γ-H2AX)and the soluble Fas(sFas)/soluble Fas ligand(sFasL)ratio in patients with nasopharyngeal carcinoma(NPC)and to evaluate the predictive value of these markers for poor prognosis after radiotherapy.METHODS This retrospective cohort study included 197 NPC patients treated at Department of Otolaryngology Head and Neck Surgery,Suining Central Hospital from May 2020 to June 2022.All patients received intensity-modulated radiotherapy(IMRT).Based on the three month radiotherapy outcome,patients were divided into remission and non remission groups.Baseline clinical characteristics,serum γ-H2AX levels,and sFas/sFasL ratios were compared between the two groups.Logistic regression was used to identify factors influencing radiotherapy prognosis.Receiver operating characteristic(ROC)curves were constructed to assess the predictive performance of serum γ-H2AX,sFas/sFasL ratio,and their combination with clinical variables.The areas under the ROC curves(AUCs)of different models were compared using DeLong's test.RESULTS Among the 197 NPC patients,three months after radiotherapy,42(21.3％)achieved complete remission(CR),118(59.9％)partial remission(PR),27(13.7％)stable disease(SD),and 10(5.1％)progressive disease(PD).The objective response rate was 81.2％(160/197).Univariate analysis showed significant differences between the remission group(CR+PR,n=160)and the non remission group(SD+PD,n=37)in terms of TNM stage,receipt of concurrent chemotherapy,serum γ-H2AX level,and sFas/sFasL ratio(P<0.05).Correlation analysis showed that serum γ-H2AX levels(r=0.327,P<0.001)and the sFas/sFasL ratio(r=0.284,P<0.001)were both significantly positively correlated with TNM stage.Furthermore,serum γ-H2AX levels and the sFas/sFasL ratio were significantly higher in patients with stage Ⅲ-Ⅳ disease than in those with stage Ⅰ-Ⅱ disease(P<0.05).Serum γ-H2AX levels and the sFas/sFasL ratio in patients receiving concurrent chemoradiotherapy were significantly lower than those in patients receiving radiotherapy alone(P<0.05).Multivariate logistic regression identified TNM stage Ⅲ-Ⅳ(OR=3.404,95％CI:1.708-6.786),elevated serum γ-H2AX(OR=6.068,95％CI:1.437-25.626),and elevated sFas/sFasL ratio(OR=3.267,95％CI:1.347-7.924)as independent risk factors for poor radiotherapy prognosis,while concurrent chemoradiotherapy was an independent protective factor(OR=0.241,95％CI:0.107-0.541).ROC analysis showed that model based on γ-H2AX and sFas/sFasL ratio yielded an AUC of 0.741(95％CI:0.672-0.809)for predicting radiotherapy prognosis.CONCLUSION Elevated pre radiotherapy serum γ-H2AX level and sFas/sFasL ratio are strongly associated with poor radiotherapy prognosis in NPC patients.Combined detection of these two markers can effectively predict radiotherapy efficacy.