摘要
目的探讨血清血管生成素样蛋白(ANGPTL)4联合肿瘤标志物用于预测结直肠癌(CRC)术前淋巴结转移(LNM)的临床价值。方法以2020年3月至2022年11月解放军联勤保障部队第九八〇医院收治的178例黏膜下浸润(T_(1))CRC患者作为研究对象。经影像学和术后组织病理学确定LNM组80例,非LNM组98例。采用酶联免疫吸附法测定血清ANGPTL4水平,并分析其表达与CRC临床病理特征的关系。采用多因素Logistic回归模型分析影响LNM的因素;采用受试者工作特征曲线(ROC)分析血清ANGPTL4联合肿瘤标志物诊断LNM的效能。结果LNM组血清ANGPTL4[1.68(1.17,3.16)AU vs.0.73(0.23,1.40)AU]、CEA水平[1.50(0.80,2.29)ng/ml vs.0.91(0.48,1.85)ng/ml]均高于非LNM组,差异具有统计学意义(P<0.05)。根据血清ANGPTL4水平中位值分为高水平组(≥0.93AU)和低水平组(<0.93AU)。血清ANGPTL4高水平亚组女性患者比例略高,LNM发生率高(P<0.05)。多因素Logistic回归模型分析,发现MSI、CEA和ANGPTL4水平是影响T_(1)期CRC患者发生LNM的独立因素(P<0.05)。ROC曲线结果显示,血清ANGPTL4和CEA可以诊断LNM(P<0.05)。当血清ANGPTL4≥0.93AU和CEA≥4.35ng/ml时,两者联合预测的曲线下面积(AUC)分别为0.878(95%CI:0.829~0.927)。结论术前血清ANGPTL4具有成为预测T_(1)期CRC患者发生LNM生物标志物的潜力,且联合肿瘤标志物诊断效能更高。
Objective To evaluate the clinical value of serum ANGPTL 4 combined with tumor markers in predicting preoperative lymph node metastasis(LNM)of colorectal cancer(CRC).Methods One hundred and seventy-eight patients with submucosal infiltration(T_(1))CRC admitted to 980th Hospital of PLA Joint Logistic Support Force from March 2020 to November 2022 were studied.Imaging and postoperative histopathology confirmed 80 cases in the LNM group and 98 cases in the non-LNM group.Serum ANGPTL4 levels were measured by enzyme-linked immunosorbent assay(ELISA),and the relationship between the expression of ANGPTL4 and the clinicopathological features of CRC was analyzed.Multivariate Logistic regression model was used to analyze the influencing factors of LNM.The efficacy of serum ANGPTL4 combined with tumor markers in the diagnosis of LNM was analyzed by receiver operating characteristic curve(ROC).Results The levels of serum ANGPTL4[1.68(1.17,3.16)AU vs.0.73(0.23,1.40)AU]and CEA[1.50(0.80,2.29)ng/ml vs.0.91(0.48,1.85)ng/ml]in LNM group were higher than those in non-LNM group.The difference was statistically significant(P<0.05).According to the median value of serum ANGPTL4 level,they were divided into high level group(≥0.93AU)and low level group(<0.93AU).The proportion of female patients with high serum ANGPTL4 level was slightly higher,and the incidence of LNM was higher(P<0.05).Multivariate Logistic regression model analysis showed that MSI,CEA and ANGPTL4 levels were independent factors affecting the occurrence of LNM in patients with stage T_(1) CRC(P<0.05).ROC curve result showed that serum ANGPTL4 and CEA could diagnose LNM(P<0.05).When serum ANGPTL4≥0.93AU and CEA≥4.35 ng/ml,the combined predicted area under the curve(AUC)was 0.878(95%CI:0.829-0.927),respectively.Conclusion Preoperative serum ANGPTL4 has the potential to be a biomarker for predicting LNM in patients with T_(1) stage CRC,and it has higher diagnostic efficacy combined with tumor markers.
作者
蒋志斌
李伟
王顺
贺屹巍
JIANG Zhibin;LI Wei;WANG Shun;HE Yiwei(The Second Department of General Surgery,980 Hospital,PLA Joint Logistic Support Force,Shijiazhuang 054300,China)
出处
《临床肿瘤学杂志》
CAS
2024年第3期260-264,共5页
Chinese Clinical Oncology
关键词
结直肠癌
血管生成素样蛋白4
淋巴结转移
黏膜下浸润
肿瘤标志物
Angiopoietin-like protein 4
Colorectal cancer
Lymph node metastasis
Submucosal infiltration
Tumor markers
