血清CC型趋化因子2、CC型趋化因子18与声门型喉癌患者临床病理参数和预后的关系

Relationship between serum CCL2,CCL18 and clinicopathological parameters and prognosis in patients with glottic carcinoma

目的研究血清CC型趋化因子2(CC type chemotactic factor 2,CCL2)、CCL18与声门型喉癌患者临床病理参数和预后的关系。方法选择邯郸市中心医院和河北工程大学附属医院2015年8月~2018年12月收治的168例声门型喉癌患者为研究对象,受试者工作特征(ROC)曲线确定血清CCL2、CCL18最佳截点,将患者分为CCL2高表达组和低表达组、CCL18高表达组和低表达组,分析血清CCL2、CCL18水平与声门型喉癌患者临床病理参数的关系,采用Kaplan-Meier曲线和Log-Rankχ^(2)检验分析血清CCL2高表达组和低表达组、CCL18高表达组和低表达组的5年无病生存率,采用Cox回归模型分析声门型喉癌预后的影响因素,并分析血清CCL2和CCL18表达与肿瘤复发/转移的关系。结果根据ROC曲线计算得出CCL2、CCL18的最佳截点分别为100.81、218.99 pg/ml。相较于CCL2、CCL18低表达组,CCL2、CCL18高表达组T3~T4a级、N1~N3级、肿瘤低分化占比明显升高(P<0.05)。168例声门型喉癌患者随访5年失访8例,完成随访160例。67例发生复发/转移,39例因复发/转移而死亡,肿瘤复发/转移率为41.88%(67/160),无病生存率为58.13%(93/160)。Kaplan-Meier生存曲分析显示,血清CCL2、CCL18高表达组5年无病生存率均明显低于血清CCL2、CCL18低表达组(P<0.05)。Cox回归分析显示,T分级升高、颈淋巴结复发、N分级升高、咽喉部复发、CCL2高表达、CCL18高表达是声门型喉癌预后不良的危险因素(P<0.05)。分析血清CCL2和CCL18表达与肿瘤复发/转移的关系发现,CCL2和CCL18均高表达时其复发/转移率明显高于CCL2和CCL18均低表达、CCL2低表达且CCL18高表达、CCL2高表达且CCL18低表达,差异比较有统计学意义(χ^(2)=10.450,P=0.015)。结论声门型喉癌患者血清CCL2、CCL18高表达与T分级、N分级、肿瘤低分化和预后不良显著相关。

OBJECTIVE To study the relationship between serum CC type chemotactic factor 2(CCL2),CC type chemotactic factor 18(CCL18)and clinicopathological parameters and prognosis of patients with glottic carcinoma.METHODS A total of 168 glottic carcinoma patients admitted to Handan Central Hospital and Hebei Engineering University Affiliated Hospital from August 2015 to December 2018 were selected as the research subjects.The receiver operating characteristic(ROC)curve was used to determine the optimal cut-off points for serum CCL2 and CCL18.Based on this,patients were divided into CCL2 high expression group and low expression group,CCL18 high expression group and low expression group.The relationship between levels of serum CCL2 and CCL18 and clinical pathological parameters of glottic carcinoma patients was analyzed.Kaplan-Meier curve and Log Rankχ^(2) test were used to analyze the 5-year disease-free survival rate of serum CCL2 high/low expression group and CCL18 high/low expression group.Cox regression model was used to analyze the influencing factors of glottic carcinoma prognosis,and the relationship between serum CCL2,CCL18 expression and tumor recurrence/metastasis was analyzed.RESULTS The optimal cut-off points for CCL2 and CCL18 calculated based on the ROC curve were 100.81 and 218.99 pg/ml,respectively.Compared with the low expression groups of CCL2 and CCL18,the high expression groups of CCL2 and CCL18 showed a significant increase in the proportion of T3-T4a,N1-N3 stages,and tumor low differentiation(P<0.05).Of the 168 glottic carcinoma patients,there were 160 patients followed up for 5 years and 8 patients lost for follow-up.There were 67 patients experienced recurrence or metastasis,and 39 patients died due to recurrence or metastasis.The tumor recurrence or metastasis rate was 41.88%(67/160),and the disease-free survival rate was 58.13%(93/160).Kaplan-Meier survival curve analysis showed that the 5-year disease-free survival rate of the high expression group of serum CCL2 and CCL18 was significantly lower than that of the low expression group of serum CCL2 and CCL18(P<0.05).Cox regression analysis showed that elevated T staging,cervical lymph node recurrence,elevated N staging,local recurrence,high expression of CCL2 and CCL18 were risk factors for poor prognosis in glottic carcinoma(P<0.05).For analysis the relationship between serum CCL2 and CCL18 expression and tumor recurrence or metastasis,it was found that when both CCL2 and CCL18 were highly expressed,the recurrence or metastasis rate was significantly higher than when both CCL2 and CCL18 were lowly expressed,CCL2 was lowly expressed and CCL18 was highly expressed,and CCL2 was highly expressed and CCL18 was lowly expressed,and the differences were statistically significant(χ^(2)=10.450,P=0.015).CONCLUSION The high expression of serum CCL2 and CCL18 in patients with glottic carcinoma is significantly correlated with T stage,N stage,tumor low differentiation,and poor prognosis.