Prediction Model Of Primary Chondrosarcoma Recurrence And IDH Gene Mutation

Objective:1.Analyze the medical records and follow-up data of patients with primary chondrosarcoma,and explore the main influencing factors of postoperative recurrence;To construct a prediction model for postoperative recurrence to identify the risk of recurrence as early as possible and provide a reference for clinicians to develop personalized treatment plans.2.To investigate the incidence and distribution of IDH1 gene mutations in patients with primary chondrosarcoma,analyze the correlation between IDH1 gene mutations and DCE-MRI quantitative parameters,and explore the value of DCE-MRI quantitative parameters in IDH1 gene mutations in primary chondrosarcoma.Methods:1.According to the criteria of arrangement,66 patients with primary chondrosarcoma who underwent surgical treatment and were pathologically confirmed at the Second Hospital of Shanxi Medical University from January 2015 to March 2021 were selected to obtain complete IDH1 gene mutations using PCR combined with gene sequencing.According to whether there is recurrence after surgery,they are divided into recurrent group and non recurrent group.Medical records and follow-up data between the two groups are analyzed to explore the main influencing factors of postoperative recurrence,and to establish a prediction model for postoperative recurrence of primary chondrosarcoma.2.66 patients with primary chondrosarcoma were divided into mutation group and non mutation group based on the IDH1 gene mutation,and their complete routine sequence（including plain scan and enhancement）and DCE-MRI images were obtained.After processing the image using Genl Q software,quantitative parameters of DCE-MRI were obtained.To investigate the incidence and distribution of IDH1 gene mutations,and to explore the value of DCE-MRI quantitative parameters in IDH1 gene mutations in primary chondrosarcoma.3.Build a database using Excel 2019 and conduct statistical analysis using SPSS software.The measurement data are described by following a normal distribution,while those that do not follow a normal distribution are described by M(P₂₅,P₇₅);Wilcoxn rank sum test was used to compare the differences between groups.Count data were represented by[n（%）],and chi-square test was used to compare differences among groups.Binary Logistic regression model and multi-layer perceptron neural network model are constructed.Draw a ROC curve for the subject,and AUC,optimal threshold,sensitivity,and specificity.The difference was statistically significant with P<0.05.Results:1.Among the 66 patients with primary chondrosarcoma,there were 22 patients with postoperative recurrence and 44 without recurrence,with an overall recurrence rate of33.3%.2.There were significant differences in histological grade,maximum tumor diameter and IDH1 gene mutations between the recurrent group and non recurrent groups（P<0.05）.The histological grade of the recurrent group was higher than that of the non recurrent group（X²=6.267,P=0.044）;The maximum tumor diameter in the recurrent group was larger than that in the non recurrent group（X²=6.028,P=0.014）;The IDH1 gene mutation rate in the recurrent group was higher than that in the non recurrent group（X²=7.940,P=0.005）.Logistic regression analysis showed that histological grade（OR=3.256,95%CI:1.063～9.974）,IDH1 gene mutation（OR=4.564,95%CI:1.095～19.019）,and diabetes（OR=10.284,95%CI:1.145～92.342）were risk factors for postoperative recurrence of primary chondrosarcoma（P<0.05）.3.The AUC value of the area under the ROC curve of the binary logistic regression model is 0.815,P<0.001,the optimal threshold value is 0.569,the sensitivity is 0.705,and the specificity is 0.864;The AUC value of the area under the ROC curve of the multi-layer perceptron neural network model is 0.816,P<0.001,the optimal threshold value is 0.632,the sensitivity is 0.716,and the specificity is 0.919.Both models are significant in predicting the recurrence of primary chondrosarcoma after surgery,and both have good predictive effects.The prediction performance of the binary Logistic regression model is slightly worse than that of the multi-layer perceptron neural network model,and there is no statistically significant difference in the prediction ability between the two models.4.Among the 66 patients with primary chondrosarcoma,38 had IDH1 gene mutations and 28 had no mutations,with a mutation rate of 57.6%.5.There were statistically significant differences between the IDH1 gene mutation group and the non mutation group in urban and rural distribution and maximum tumor diameter（P<0.05）.The proportion of urban（50%）and rural（50%）in the IDH1 gene mutation group is equal,while the proportion of urban（75%）in the non mutation group is higher than that in rural（25%）,X²=4.220,P=0.040;The maximum tumor diameter in the IDH1 gene mutation group was larger than that in the non mutation group（X²=5.556,P=0.018）.6.Among the quantitative parameters of DCE-MRI,the Ktrans value of the IDH1gene mutation group[0.261（0.107,0.418）]is higher than that of the non mutation group[0.112（0.076,0.259）],Z=-2.491,P=0.013;The Kep value of IDH1 gene mutation group[0.614（0.405,0.817）]was higher than that of the non mutation group[0.349（0.283,0.465）],Z=-3.873,P<0.001.7.The AUC value of the area under the ROC curve for the Ktrans value is 0.680,P=0.013;The AUC value of the area under the ROC curve of Kep value is 0.781,P<0.001;The AUC value of the area under the ROC curve for the combination of Ktrans and Kep values is 0.852,P<0.001.The combined predictive performance of the two indicators is superior to the diagnostic performance of any single indicator.Conclusions:1.By analyzing the influencing factors of postoperative recurrence of primary chondrosarcoma,it is concluded that high histological grade,IDH1 gene mutation and diabetes are the risk factors of postoperative recurrence of primary chondrosarcoma,which can provide important information for the prediction of postoperative recurrence of primary chondrosarcoma.2.The binary logistic regression and multi-layer perceptron neural network model for predicting postoperative recurrence of primary chondrosarcoma have reference significance,and can be used as a tool for evaluating the risk of postoperative recurrence of primary chondrosarcoma,providing a basis for building more accurate models in future research.3.IDH gene is highly mutated in patients with primary chondrosarcoma and is an important molecular marker of primary chondrosarcoma.4.The quantitative parameters Ktrans and Kep of DCE-MRI can be used as imaging markers for noninvasive prediction of IDH1 gene mutations,and their combined prediction efficiency is superior to any single indicator.Predict the IDH1 gene mutation status before surgery,thereby providing a reference basis for clinicians to personalize treatment plans based on tumor genetics.