Clinical significance and prediction model construction of PIK3CA gene in circulating tumor cells for prognostic evaluation of colorectal cancer patients
10.3969/j.issn.1000-4718.2025.11.011
- VernacularTitle:循环肿瘤细胞中PIK3CA基因对结直肠癌患者预后评估的临床意义及其预测模型构建
- Author:
Li LI
1
;
Lin WANG
1
;
Jiangxia FAN
1
Author Information
1. 广州市红十字会医院肿瘤科,广东 广州 510220
- Publication Type:Journal Article
- Keywords:
colorectal cancer;
circulating tumor cells;
PIK3CA gene;
predictive model;
nomogram
- From:
Chinese Journal of Pathophysiology
2025;41(11):2166-2174
- CountryChina
- Language:Chinese
-
Abstract:
AIM:To investigate the relationship between the expression of phosphatidylinositol 3-kinase cata-lytic subunit alpha(PIK3CA)gene in circulating tumor cells(CTCs)and the prognosis of colorectal cancer patients,and to construct a corresponding predictive model.METHODS:This retrospective study included 110 newly diagnosed and treated colorectal cancer patients at Guangzhou Red Cross Hospital from January 2019 to December 2021.Peripheral blood samples were collected and tested for CTC and PIK3CA gene at first visit.We determined the expression levels of PIK3CA gene in CTCs of different subtypes by typing and counting CTCs.Patients were randomly divided into training group(n=77)and validation group(n=33)in a ratio of 7∶3.Univariate and multivariate Cox regression analyses were per-formed to assess the associations between clinicopathological factors and patient prognosis.A nomogram model was con-structed to predict survival of patients at 6,12 and 24 months.The model performance was evaluated and validated using the concordance index(C-index),receiver operating characteristic(ROC)curve,and decision curve analysis(DCA)in the validation group.And then,the clinical application value of the model was further evaluated using the DCA curve.RESULTS:Univariate analysis showed that N1 and N2 stage,M stage(M1),carcinoembryonic antigen(CEA)level,liver metastasis,and lung metastasis were independent risk factors for prognosis(P<0.01).Multivariate analysis showed that age,gender,N1 stage,TNM stage(IIC,IIIA,IV),CEA level,liver metastasis,lung metastasis,and PIK3CA ex-pression in mixed CTCs were correlated with prognosis(P<0.05).The nomogram model based on PIK3CA expression demonstrated excellent predictive performance in the validation group,with areas under the ROC curve(AUC)of 0.952(6 months),0.931(12 months),and 0.957(24 months).The DCA curve showed that the model had a high net benefit across a wide range of decision thresholds.CONCLUSION:The different expression levels of PIK3CA gene in CTC are correlated with the survival rate of patients.Especially in mixed CTCs,high expression of PIK3CA gene is associated with shorter overall survival.The clinical prediction model nomogram has good clinical application value in predicting the sur-vival rate of colorectal cancer patients.The decision curve analysis also shows that the model has good net benefits and clinical application value.
