E-Cad、G-17、HER-2与胃癌术后复发风险的相关性

doi:10.3969/j.issn.1673-8640.2022.01.008

摘要/Abstract

摘要：

目的探讨血清上皮型钙黏蛋白（E-Cad）、胃泌素-17（G-17）水平和肿瘤组织中人类表皮生长因子受体2（HER-2）表达与胃癌患者术后复发风险的相关性。方法选取行胃癌根治术治疗的胃癌患者92例,检测术前血清E-Cad、G-17水平和肿瘤组织HER-2的表达。对所有患者随访5年,以胃癌复发或随访满5年为随访终点。以胃良性病变患者92例作为对照组。收集所有胃癌患者的临床资料（性别、年龄、临床分期、分化程度、复发情况等）。采用受试者工作特征（ROC）曲线评估各项指标判断胃癌复发的效能。采用Cox回归分析评估影响胃癌患者复发的危险因素。采用Kaplan-Meier生存曲线评估胃癌患者的5年复发情况。结果胃癌组血清G-17水平和肿瘤组织HER-2阳性率均显著高于对照组（P=0.000）,血清E-Cad水平显著低于对照组（P=0.000）。血清E-Cad、G-17水平及肿瘤组织HER-2阳性率与胃癌的TNM分期、分化情况及是否复发有关（P<0.05）,与性别无关（P>0.05）。ROC曲线分析结果显示,E-Cad、G-17、HER-2单项检测与联合检测判断胃癌复发的曲线下面积（AUC）分别为0.775、0.822、0.603、0.950。Kaplan-Meier生存曲线分析结果显示,胃癌复发患者E-Cad低表达组复发率高于高表达组（P<0.05）,而G-17低表达组、HER-2低表达组复发率低于G-17高表达组、HER-2高表达组（P<0.05）。Cox回归分析结果显示,E-Cad水平降低、G-17水平升高、HER-2表达升高均是胃癌复发的危险因素[风险比（HR）分别为0.835、1.568、3.981,95%可信区间（CI）分别为0.767~0.909、1.292~1.904、1.504~10.538]。结论 E-Cad、G-17、HER-2在预测胃癌患者根治术后复发中均有重要价值。

关键词: 上皮型钙黏蛋白, 胃泌素-17, 人类表皮生长因子受体2, 胃癌, 复发

Abstract:

Objective To investigate the correlation between serum epithelial cadherin（E-Cad）and gastrin-17（G-17）levels and human epidermal growth factor receptor-2（HER-2） expression in tumor tissues and the risk of postoperative recurrence in patients with gastric cancer. Methods Totally,92 patients with gastric cancer who underwent radical gastric cancer treatment were enrolled,and the serum E-Cad and G-17 levels and the tumor tissue HER-2 expression were determined before the operation. All the patients were followed up for 5 years,with gastric cancer recurrence or 5 years of follow-up as the follow-up endpoint. Totally,92 patients with benign gastric lesions were enrolled as control group. The clinical data（sex,age,clinical stage,degree of differentiation,recurrence and so on） of all the gastric cancer patients were collected. Receiver operating characteristic（ROC） curve was used to evaluate the efficiency of various indicators in judging the recurrence of gastric cancer. Cox regression analysis was used to evaluate the risk factors affecting the recurrence of gastric cancer. Kaplan-Meier survival curve was used to evaluate the 5-year recurrence of gastric cancer. Results The serum G-17 level and the positive rate of HER-2 in gastric cancer group were higher than those in control group（P=0.000）,and the serum E-Cad level was lower than that in control group（P=0.000）. The levels of serum E-Cad and G-17 and the positive rate of HER-2 were correlated with TNM stage,differentiation and recurrence of gastric cancer（P<0.05）,but there was no correlation with sex（P>0.05）. ROC curve analysis showed that the areas under curves（AUC） of single determinations of E-Cad,G-17 and HER-2 and combined determination were 0.775,0.822,0.603 and 0.950,respectively. Kaplan-Meier survival curve analysis showed that the recurrence rate of low expression of E-Cad was higher than that of high expression group（P<0.05）,while the recurrence rate of low expression of G-17 and low expression of HER-2 was lower than that of high expression of G-17 and high expression of HER-2（P<0.05）. Cox regression analysis showed that decreased E-Cad level,increased G-17 level and increased HER-2 expression were risk factors for gastric cancer recurrence [hazard ratios（HR） were 0.835,1.568 and 3.981,95% confidence intervals（CI） were 0.767-0.909,1.292-1.904 and 1.504-10.538,respectively]. Conclusions E-Cad,G-17 and HER-2 play roles in the prediction of gastric cancer recurrence after radical gastric cancer treatment.

Key words: Epithelial cadherin, Gastrin-17, Human epidermal growth factor receptor-2, Gastric cancer, Recurrence

中图分类号:

R446.1

茆政, 钱增堃, 应斐, 王昭俐, 肖群, 崔凡. E-Cad、G-17、HER-2与胃癌术后复发风险的相关性[J]. 检验医学, 2022, 37(1): 41-46.

MAO Zheng, QIAN Zengkun, YING Fei, WANG Zhaoli, XIAO Qun, CUI Fan. Correlation between E-Cad,G-17,HER-2 and postoperative recurrence risk of gastric cancer[J]. Laboratory Medicine, 2022, 37(1): 41-46.

图/表 8

参考文献 19

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组别	例数	E-Cad/ （ng/mL）	G-17/ （pg/mL）	HER-2阳性/ [例（%）]
胃癌组	92	20.92±5.11	25.68±6.33	27（29.35）
对照组	92	32.76±4.14	10.67±3.22	5（5.43）
统计值		17.268	20.272	20.950
P值		0.000	0.000	0.000

组别	例数	E-Cad/ （ng/mL）	G-17/ （pg/mL）	HER-2阳性/ [例（%）]
胃癌组	92	20.92±5.11	25.68±6.33	27（29.35）
对照组	92	32.76±4.14	10.67±3.22	5（5.43）
统计值		17.268	20.272	20.950
P值		0.000	0.000	0.000

临床病理参数	例数	E-Cad/（ng/mL）	G-17/ （pg/mL）	HER-2阳性/ [例（%）]	临床病理参数	例数	E-Cad/ （ng/mL）	G-17/ （pg/mL）	HER-2阳性/ [例（%）]
性别					分化情况
男性	55	20.47±0.30	26.37±1.41	15（27.27）	低分化	35	16.42±5.88	23.09±5.14	2（5.71）
女性	37	20.42±0.21	26.09±1.46	12（32.43）	中分化	30	19.10±4.87	26.08±5.17	4（13.33）
统计值		0.940	0.914	0.123	高分化	27	22.10±4.87	29.55±5.17	21（77.78）
P值		0.350	0.360	0.940	统计值		12.090	11.202	17.989
TNM分期					P值		0.000	0.000	0.000
Ⅰ~Ⅱ期	45	17.01±5.42	23.69±1.15	5（11.11）	是否复发
Ⅲ~Ⅳ期	47	22.03±5.55	29.79±1.14	22（46.81）	复发	25	18.74±5.37	28.33±1.33	18（72.00）
统计值		4.389	24.704	11.222	未复发	67	21.73±5.51	24.69±1.57	9（1.00）
P值		0.000	0.000	0.000	统计值		2.359	16.968	30.122
					P值		0.020	0.000	0.000

临床病理参数	例数	E-Cad/（ng/mL）	G-17/ （pg/mL）	HER-2阳性/ [例（%）]	临床病理参数	例数	E-Cad/ （ng/mL）	G-17/ （pg/mL）	HER-2阳性/ [例（%）]
性别					分化情况
男性	55	20.47±0.30	26.37±1.41	15（27.27）	低分化	35	16.42±5.88	23.09±5.14	2（5.71）
女性	37	20.42±0.21	26.09±1.46	12（32.43）	中分化	30	19.10±4.87	26.08±5.17	4（13.33）
统计值		0.940	0.914	0.123	高分化	27	22.10±4.87	29.55±5.17	21（77.78）
P值		0.350	0.360	0.940	统计值		12.090	11.202	17.989
TNM分期					P值		0.000	0.000	0.000
Ⅰ~Ⅱ期	45	17.01±5.42	23.69±1.15	5（11.11）	是否复发
Ⅲ~Ⅳ期	47	22.03±5.55	29.79±1.14	22（46.81）	复发	25	18.74±5.37	28.33±1.33	18（72.00）
统计值		4.389	24.704	11.222	未复发	67	21.73±5.51	24.69±1.57	9（1.00）
P值		0.000	0.000	0.000	统计值		2.359	16.968	30.122
					P值		0.020	0.000	0.000

项目	AUC（95%CI）	最佳临界值	敏感性/%	特异性/%	敏感性/%	阳性预测值/%	阴性预测值/%	Youden指数
E-Cad	0.775（0.520~0.872）	15.32 ng/mL	92.59	40.48	92.59	34.25	89.47	33.07
G-17	0.822（0.230~0.974）	22.71 ng/mL	81.48	51.11	81.48	34.38	82.14	32.59
HER-2	0.603（0.600~0.746）	2+	88.89	35.14	88.89	31.58	81.25	24.03
联合检测	0.950（0.112~0.965）	0.64	77.78	74.07	77.78	80.77	90.91	51.85