术前血清Ⅳ型胶原和富含半胱氨酸蛋白61水平与腹腔镜直肠癌根治术患者术后复发的关系

Relationship between preoperative serum COLIV and Cry61 levels and postoperative recurrence in patients underwent laparoscopic radical resection of rectal cancer

摘要:

目的 探讨分析术前血清Ⅳ型胶原（COLⅣ）和富含半胱氨酸蛋白61（Cry61）水平与腹腔镜直肠癌根治术患者术后复发的关系。方法 选取2020年2月－2021年2月该院收治的100例行腹腔镜直肠癌根治术的患者，随访至2022年2月28日，根据术后是否复发将患者分为复发组（34例）和未复发组（66例）。比较两组患者基线资料，采用双抗体夹心酶联免疫吸附试验检测血清COLⅣ和Cry61水平，分析术前血清COLⅣ和Cry61水平与腹腔镜直肠癌根治术患者术后复发的关系。结果 两组患者性别、年龄和病程比较，差异均无统计学意义（P > 0.05），而两组患者肿瘤分期、分化程度、淋巴转移、术前血清COLⅣ和Cry61水平比较，差异均有统计学意义（P < 0.05）。多因素Logistic回归分析结果显示，肿瘤分期（OR＾ = 3.384，95%CI：1.437～7.969）、分化程度（OR＾ = 3.121，95%CI：1.493～6.521）、淋巴转移（OR＾ = 3.476，95%CI：1.274～9.483）、术前血清COLⅣ水平（OR＾ = 3.165，95%CI：1.290～7.765）和Cry61水平（OR＾ = 2.924，95%CI：1.543～5.540）是腹腔镜直肠癌根治术患者术后复发的独立影响因素（OR＾ > 1，P < 0.05）。术前血清COLⅣ水平截断值为164.58 ng/mL时，预测腹腔镜直肠癌根治术患者术后复发的受试者操作特征曲线（ROC）的曲线下面积（AUC）为0.75（95%CI：0.678～0.907），此时的敏感度和特异度分别为78.34%和69.52%；术前血清Cry61水平截断值为447.36 ng/L时，预测腹腔镜直肠癌根治术患者术后复发的ROC AUC为0.73（95%CI：0.714～0.912），此时的敏感度和特异度分别为75.63%和68.45%；两者联合检测预测腹腔镜直肠癌根治术患者术后复发的ROC AUC为0.79（95%CI：0.752～0.936），此时的敏感度和特异度分别为82.49%和69.31%。结论 术前血清COLⅣ和Cry61水平升高是腹腔镜直肠癌根治术患者术后复发的独立影响因素，术前血清COLⅣ和Cry61水平，对腹腔镜直肠癌根治术后复发，具有较好的预测价值。

Abstract:

Objective To explore the relationship between preoperative serum collagen IV (COL IV) and cysteine-rich 61 (Cry61) levels and postoperative recurrence in patients underwent laparoscopic radical resection of rectal cancer.Methods 100 patients underwent laparoscopic radical resection of rectal cancer from February 2020 to February 2021 were selected and followed-up until February 28, 2022. The patients were divided into recurrence group (34 cases) and non-relapse group (66 cases). The baseline data of patients in the two groups were compared. Double-antibody sandwich enzyme-linked immunosorbent assay was used to detect serum collagen IV and Cry61 levels. Analyzed the relationship between preoperative serum COL IV and Cry61 level and postoperative recurrence in patients undergoing laparoscopic radical resection of rectal cancer.Results There were no significant differences in gender, age, and disease duration between the two groups (P > 0.05), but there were significant differences in tumor stage, degree of differentiation, lymph node metastasis, preoperative serum COLIV, and preoperative serum Cry61 between the two groups (P < 0.05). Multivariate Logistic regression analysis showed that tumor stage (OR＾ = 3.384, 95%CI: 1.437~7.969), degree of differentiation (OR＾ = 3.121, 95%CI: 1.493 ~ 6.521), lymph node metastasis (OR＾ = 3.476, 95%CI: 1.274 ~ 9.483), preoperative serum COL IV (OR＾ = 3.165, 95%CI: 1.290 ~ 7.765), and preoperative serum Cry61 (OR＾ = 2.924, 95%CI: 1.543 ~ 5.540) were independent influencing factors of postoperative recurrence (OR＾ > 1, P < 0.05). When the cut-off value of preoperative serum COL IV level was 164.58 ng/mL, the area under the curve (AUC) of receiver-operating characteristic curve (ROC curve) for predicting postoperative recurrence in patients with laparoscopic radical resection of rectal cancer was 0.75 (95%CI: 0.678 ~ 0.907). At this time, the sensitivity and specificity were 78.34% and 69.52%, respectively. When the cut-off value of preoperative serum Cry61 level was 447.36 ng/L, AUC of the ROC curve for predicting postoperative recurrence in patients with laparoscopic radical resection of rectal cancer was 0.73 (95%CI: 0.714 ~ 0.912). At this time, the sensitivity and specificity were 75.63% and 68.45%, respectively. AUC of the ROC curve of the combined detection of the two for predicting postoperative recurrence in patients with laparoscopic radical resection of rectal cancer was 0.79 (95%CI: 0.752 ~ 0.936). The sensitivity and specificity were 82.49% and 69.31%, respectively.Conclusion Preoperative serum COLIV and Cry61 levels are independent influencing factors of postoperative recurrence in patients with laparoscopic radical resection of rectal cancer. Preoperative serum COLⅣ and Cry61 levels have good predictive value for postoperative recurrence after laparoscopic radical resection of rectal cancer.