外周血微小RNA-135b-5p及微小RNA-144联合检测对结直肠癌腹腔镜根治术后复发的预测价值OA

Objective To explore the predictive value of combined detection of peripheral blood microRNA-135b-5p(miR-135b-5p)and microRNA-144(miR-144)for recurrence after laparoscopic radical resection in patients with colorectal cancer(CRC).Methods A total of 256 CRC patients who underwent laparoscopic radical resection were prospectively enrolled.All patients were followed up for 3 years postoperatively,during which 5 were lost during follow-up;ultimately,251 patients were in-cluded and divided into recurrence group and non-recurrence group.The associations of miR-135b-5p and miR-144 expression levels with the risk of postoperative recurrence were analyzed.Multivariate logistic regression analysis was performed to identify factors influencing postoperative recurrence in CRC patients.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)was calculated to evaluate the predictive performance of miR-135b-5p and miR-144,both indicator alone and their combination,for postoperative recurrence.Results A total of 251 pa-tients completed the follow-up,and the 3-year postoperative recurrence rate was 29.08％(73/251).Significant differences were observed between the two groups in terms of clinical stage,vascular in-vasion,carcinoembryonic antigen(CEA),systemic immune-inflammation index(SII),and neutro-phil-to-lymphocyte ratio(NLR)(P＜0.05).The expression level of miR-135b-5p in peripheral blood was higher in the recurrence group than that in the non-recurrence group,whereas the expres-sion level of miR-144 was lower in the recurrence group than that in the non-recurrence group(both P＜0.05).Smooth curve fitting revealed a significant linear positive corr-elation between miR-135b-5p expression and the risk of postoperative recurrence and a significant linear negative correlation be-tween miR-144 expression and the risk of postoperative recurrence(P＜0.05).Multivariate logistic regression analysis showed that clinical stage Ⅲ,SII≥521,NLR≥2.37,and elevated miR-135b-5p expression were independent risk factors for postoperative recurrence in CRC patients,whereas elevat-ed miR-144 expression was an independent protective factor(P＜0.05).The ROC curves showed that the AUCs for miR-135b-5p and miR-144 alone in predicting postoperative recurrence were 0.765 and 0.751,respectively,and the AUC for the combined prediction increased to 0.863,which was sig-nificantly higher than that of either marker alone(P＜0.05).In the temporal validation set,the combined prediction results were highly consistent with the actual clinical follow-up results,with an overall accuracy of 92.19％and a Kappa value of 0.829(P＜0.001).Conclusion Preoperative peripheral blood miR-135b-5p and miR-144 expression levels are associated with recurrence after laparoscopic radical resection in CRC patients.The combined detection of the two markers demon-strates excellent predictive performance and good clinical consistency,which facilitates postoperative risk stratification and provides an important basis for formulating individualized comprehensive treat-ment and follow-up strategies.