Sasmita Dhyas Ma, Anwar Sumadi L, Heriyanto Didik S, Paramita Dewi K, Hendrawan Fandi, Aryandono Teguh
Department of Oncological Surgery, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
Department of Surgery, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.
Narra J. 2025 Apr;5(1):e1601. doi: 10.52225/narra.v5i1.1601. Epub 2025 Jan 13.
Telomere repeat binding factor 2 (TRF2) is currently a novel tumor marker, yet its clinical implication has not been investigated. The aim of this study was to investigate the prognostic value of circulating TRF2 and leukocyte telomere length in 5-year mortality in breast cancer patients. In this cohort retrospective study, breast cancer patients were included and the length of telomeres and circulating TRF2 were quantified. Receiver operating characteristics and the Youden index were used to determine the optimal cut-off. To analyze the overall survival rate in five years, Kaplan Meier analysis was used, while the prognostic value of both variables was analyzed in Cox proportional hazard regression on both univariate and multivariate models. Our data indicated that the optimal cut-off points for TRF2 and leukocyte telomere length were 598 pg/mL and 0.93 kb, respectively. Based on the optimal cut-off points, the participant's data was grouped, and our data indicated that the high TRF2 group had a poorer overall survival rate in comparison to the low group (91.3% vs 83.87%; log-rank test; < 0.01). The overall survival between short and long telomeres was comparable (88.24% vs 88.37%; log-rank test; = 0.64). TRF2 (hazard ratio (HR): 3.66; 95%CI: 1.45-9.29) and molecular subtype ( = 0.04) were identified as independent factors to predict mortality. In conclusion, a high circulating TRF2 in breast cancer participants was associated with lower overall 5-year survival rates in comparison with the low TRF2 group. Moreover, high TRF2 could predict the mortality of the breast cancer population to be 3.66 times higher than the lower group. In contrast, telomere length was not associated with overall survival rate nor predicting mortality in five years.
端粒重复结合因子2（TRF2）目前是一种新型肿瘤标志物，但其临床意义尚未得到研究。本研究的目的是探讨循环TRF2和白细胞端粒长度对乳腺癌患者5年死亡率的预后价值。在这项队列回顾性研究中，纳入了乳腺癌患者，并对端粒长度和循环TRF2进行了定量分析。采用受试者工作特征曲线和尤登指数确定最佳截断值。为分析5年总生存率，采用Kaplan Meier分析，而在单变量和多变量模型的Cox比例风险回归中分析了这两个变量的预后价值。我们的数据表明，TRF2和白细胞端粒长度的最佳截断点分别为598 pg/mL和0.93 kb。基于最佳截断点，对参与者的数据进行分组，我们的数据表明，与低TRF2组相比，高TRF2组的总生存率较差（91.3%对83.87%；对数秩检验；P<0.01）。短端粒和长端粒之间的总生存率相当（88.24%对88.37%；对数秩检验；P = 0.64）。TRF2（风险比（HR）：3.66；95%置信区间：1.45 - 9.29）和分子亚型（P = 0.04）被确定为预测死亡率的独立因素。总之，与低TRF2组相比，乳腺癌患者中循环TRF2水平高与5年总生存率较低相关。此外，高TRF2可预测乳腺癌人群的死亡率比低TRF2组高3.66倍。相比之下，端粒长度与总生存率无关，也不能预测5年死亡率。
