摘要
目的探讨血清半胱氨酸蛋白酶抑制蛋白C(CysC)、血清和糖皮质激素调节激酶1(SGK1)、同型半胱氨酸(Hcy)与肺癌患者术后淋巴结转移的相关性及预测价值。方法前瞻性选择2016年11月至2018年6月眉山市中医医院收治的行肿瘤切除、系统性淋巴结清扫术治疗的131例Ⅰ~ⅢA期非小细胞肺癌(NSCLC)患者,术后随访3年,按照随访期是否发生淋巴结转移分为转移组(42例)和未转移组(89例)。术后次日检测患者血清CysC、SGK1、Hcy水平,比较不同TNM分期、分化程度、组织学类型患者CysC、SGK1、Hcy水平,比较术后是否转移组间临床病理特征及3个指标水平的差异;采用Spearman法分析3个指标与患者临床病理特征的关系;采用多因素logisitic回归模型分析术后淋巴结转移的影响因素(CysC、SGK1、Hcy以中位水平为临界值,>中位水平为水平高);以病理检查结果为金标准,应用受试者工作特征(ROC)曲线分析3个指标水平单独及联合对术后淋巴结转移的预测价值。结果TNM分期ⅢA期患者血清CysC、SGK1、Hcy水平均高于Ⅰ~Ⅱ期患者,肿瘤低分化患者均高于中高分化患者,非鳞状细胞癌患者均高于鳞状细胞癌患者,差异均有统计学意义(均P<0.05)。Spearman相关性分析显示,血清CysC、SGK1、Hcy水平与患者TNM分期(r值分别为0.454、0.672、0.645)、分化程度(r值分别为-0.399、-0.403、-0.451)、组织学类型(r值分别为0.528、0.760、0.611)有相关性(均P<0.001)。转移组血清CysC[(1.37±0.30)mg/L比(1.16±0.25)mg/L]、SGK1[(53±4)pg/ml比(41±3)pg/ml]、Hcy[(18.3±2.3)μmol/L比(15.4±1.8)μmol/L]水平均高于未转移组(均P<0.001)。多因素logistic回归分析显示,TNM分期ⅢA期(OR=2.944,95%CI 1.556~6.847,P=0.004)及CysC水平高(>1.23 mg/L,OR=2.431,95%CI 1.402~5.226,P=0.008)、SGK1水平高(>50 pg/ml,OR=4.010,95%CI 1.815~11.748,P=0.004)、Hcy水平高(>16.8μmol/L,OR=3.742,95%CI 1.747~9.142,P=0.001)是术后淋巴结转移的独立危险因�
Objective To explore the correlation of serum cystatin C(CysC),serum and glucocorticoid-regulated kinase 1(SGK1)and homocysteine(Hcy)with postoperative lymph node metastasis in patients with lung cancer and their predictive values.Methods One hundred and thirty-one patients with stageⅠ-ⅢA non-small cell lung cancer(NSCLC)who underwent tumor resection and systematic lymph node dissection in Meishan Hospital of Traditional Chinese Medicine from November 2016 to June 2018 were prospectively selected.Patients received a 3-year follow-up after surgery,and were classified into metastasis group(42 cases)and non-metastasis group(89 cases)according to the presence or absence of lymph node metastasis during the follow-up period.Serum CysC,SGK1 and Hcy levels were detected at the 1st day after surgery,and the levels of the three indicators were compared among patients with different TNM stages,differentiation degrees and histological types.Meantime,the clinicopathological characteristics and levels of the three indicators were also compared between metastasis group and non-metastasis group.Spearman analysis was conducted to discuss the correlation between the three indicators and clinicopathological characteristics of patients.Multivariate logistic regression analysis was performed to screen the factors affecting postoperative lymph node metastasis(the median levels of CysC,SGK1 and Hcy were used as the cut-off values,>the median level was a high level).Taking the pathological examination results as the gold standard,receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of level of the three indicators alone or in combination for postoperative lymph node metastasis.Results The serum levels of CysC,SGK1 and Hcy in patients with TNM stageⅢA were higher than those in patients with stageⅠ-Ⅱ;the serum levels of CysC,SGK1 and Hcy in patients with poorly differentiated tumors were higher than those in patients with medium and well-differentiated tumors;the serum levels of CysC,SGK
作者
刘丽
杨洋
张万里
陈涛
张换友
杨建英
Liu Li;Yang Yang;Zhang Wanli;Chen Tao;Zhang Huanyou;Yang Jianying(Department of Oncology,Meishan Hospital of Traditional Chinese Medicine,Meishan 620020,China)
出处
《肿瘤研究与临床》
CAS
2022年第7期493-497,共5页
Cancer Research and Clinic
