早期胃癌患者血清血管生成素-2和CC趋化因子配体22水平对内镜黏膜下剥离术后复发的预测价值

Predictive value of serum Ang-2 and CCL22 levels in early gastric cancer patients for recurrence after endoscopic submucosal dissection

摘要:

目的 探讨早期胃癌患者血清血管生成素-2（Ang-2）和CC趋化因子配体22（CCL22）水平对内镜黏膜下剥离术（ESD）后复发的预测价值。方法 选取2019年2月－2023年2月于该院采用ESD治疗的早期胃癌患者236例，术后随访1年，根据复发情况，分为复发组（49例）和未复发组（187例）。采用酶联免疫吸附试验（ELISA），检测血清Ang-2和CCL22的表达水平；采用Pearson法，分析ESD后复发的早期胃癌患者血清Ang-2与CCL22的相关性；采用多因素Logistic回归模型，分析影响早期胃癌患者ESD后复发的独立危险因素；绘制受试者操作特征曲线（ROC curve），分析Ang-2和CCL22的预测价值。结果 与未复发组相比，复发组Ang-2和CCL22表达水平明显升高，差异均有统计学意义（P < 0.05）；复发组黏膜下层浸润、低分化占比及ESD未完整切除占比明显高于未复发组，差异均有统计学意义（P < 0.05）；采用Pearson相关性分析，结果显示，复发组Ang-2与CCL22呈正相关（r = 0.74，P < 0.05）；多因素Logistic回归分析显示，Ang-2水平升高、CCL22水平升高、低分化和黏膜下层浸润，是影响早期胃癌患者ESD后复发的独立危险因素（P < 0.05）；ROC curve分析结果显示，单独使用Ang-2作为预测指标时，曲线下面积（AUC）为0.868，单独使用CCL22作为预测指标时，AUC为0.783，将Ang-2和CCL22联合检测作为预测指标时，AUC增高至0.925，明显优于Ang-2或CCL22单独检测（Z = 2.18，Z = 2.84；P < 0.05）。结论 ESD后复发的早期胃癌患者，血清中Ang-2和CCL22水平增加，两者表达水平与早期胃癌患者ESD后复发的情况存在关联。Ang-2和CCL22联合检测，预测早期胃癌患者ESD后复发，具有较高的应用价值。

Abstract:

Objective To investigate the predictive value of serum angiopoietin-2 (Ang-2) and CC chemokine ligand 22 (CCL22) levels in patients with early gastric cancer for recurrence after endoscopic submucosal dissection (ESD).Methods The subjects were 236 patients with early gastric cancer who underwent treatment from February 2019 to February 2023. They were followed up for one year. According to the recurrence, they were divided into recurrent group (49 cases) and non recurrent group (187 cases). Enzyme linked immunosorbent assay (ELISA) was applied to detect the expression levels of serum Ang-2 and CCL22. Pearson method was applied to analyze the correlation between serum Ang-2 and CCL22 in early gastric cancer patients who experienced recurrence after receiving ESD. A multivariate Logistic regression model was used to analyze the independent risk factors influencing the recurrence after ESD in early gastric cancer. The receiver operating characteristic curve (ROC curve) was drawn to analyze the predictive value of Ang-2 and CCL22.Results Compared with the non recurrent group, the expression levels of Ang-2 and CCL22 in the recurrent group increased, the differences were statistically significant (P < 0.05). The recurrent group showed significantly higher rates of submucosal infiltration, low differentiation, and not complete ESD resection compared to the non recurrent group (P < 0.05). Pearson correlation analysis showed that Ang-2 was positively correlated with CCL22 (r = 0.74, P < 0.05) in recurrent group. According to multivariate Logistic regression analysis, elevated Ang-2 levels, elevated CCL22 levels, low differentiation, and submucosal infiltration were independent risk factors for recurrence in early gastric cancer patients after ESD (P < 0.05). ROC curve analysis results showed that the area under the curve (AUC) when using Ang-2 as the predictor alone was 0.868, the AUC when using CCL22 alone was 0.783, the AUC of Ang-2 combined CCL22 as predictive indicators was 0.925, which was higher than using any single indicator alone (Z = 2.18, Z = 2.84; P < 0.05).Conclusion The serum levels of Ang-2 and CCL22 increase in early gastric cancer patients who experience recurrence after ESD, and their expression levels are related to the recurrence of early gastric cancer patients after ESD. The combined detection of Ang-2 and CCL22 has high predictive value for the recurrence of early gastric cancer patients after ESD.