血清PDCD5和PCNA表达对肺癌患者短期预后的评估价值

The evaluated values of serum levels of PDCD5 and PCNA to the short-term prognosis in patients with lung cancer

目的探讨肺癌患者血清肿瘤标志物程序性细胞死亡5(PDCD5)和增殖细胞核抗原(PCNA)的表达及预后研究。方法回顾性选取2015年7月至2017年7月海南医学院第一附属医院收治的98例肺癌患者(肺癌组),同时选取98例健康人设置为对照组。分别给予两组患者采用酶联免疫吸附法(ELISA)对血清中PDCD5和PCNA肿瘤标志物进行测定,并比较两组临床指标差异。随访6个月,根据预后结局分为:生存组与死亡组,比较两组血清PDCD5和PCNA水平。应用多元Logistic回归分析上述各临床指标与生存情况的相关性。绘制受试者工作特征曲线(ROC)评估血清PDCD5和PCNA水平对肺癌患者短期预后的判断价值。结果与对照组相比,肺癌组血清PDCD5显著较低,而PCNA表达水平显著较高(P<0.05)。与高分化、Ⅰ~Ⅱ期和无淋巴结转移肺癌患者相比,低中分化、Ⅲ~Ⅳ期以及有淋巴结转移的肺癌患者PDCD5表达水平显著较低,而PCNA表达水平显著较高(P<0.05)。随访6月,与生存组相比,死亡组血清PDCD5显著较低,而PCNA表达水平显著较高(P<0.05)。多元Logistic回归分析显示,血清PCNA高表达(OR=2.426,P=0.027)、病理低分化(OR=1.862,P=0.020)、TNM分期III-IV期(OR=1.726,P=0.038)与存在淋巴结转移(OR=1.943,P=0.034)为肺癌患者短期预后危险因素,而血清PDCD5高表达是保护性因素(OR=0.357,P=0.016)。ROC曲线显示,血清PDCD5截断值为456.5 pg/ml及PCNA截断值为50.8 pg/ml,预测肺癌患者短期预后死亡的AUC为0.849(P=0.030),灵敏度为85.2%(95%CI:0.802~0.917),特异度为86.3%(95%CI:0.821~0.936)。结论肺癌患者血清PDCD5表达水平降低,PCNA表达水平增高,血清PDCD5和PCNA的表达水平联合检测能较好地预测肺癌患者的短期预后。

Objective To explore the expression and prognosis value of serum tumor markers PDCD5 and PCNA in patients with lung cancer.Methods The 98 patients diagnosed to lung cancer in our hospital from July 2015 to July 2017 were collected to lung cancer group.And the 98 healthy people were selected to control group.The serum levels of PDCD5 and PCNA were detected by the enzyme linked immuno sorbent assay(ELISA)and compared between two groups.After follow-up 6 months,all the patients were divided into two groups according to the prognosis,including survival group and death group.The serum levels of PDCD5 and PCNA were compared between two groups.Multivariate Logistic analysis was performed to evaluate the correlation of the serum levels of above indexes and survival rate.The diagnostic value of the serum levels of PDCD5 and PCNA to the prognosis of the patients with lung cancer were analyzed by receiver operating characteristic curves(ROC).Results Compared to control group,the serum level of PDCD5 in lung cancer group was lower(all P<0.05),and the serum level of PCNA in lung cancer group was higher(P<0.05).Compared to the patients with high differentiation,stage I-II group,and non-lymph node metastasis,the serum level of PDCD5 was lower in patients with poor differentiation,stage III-IV group,and lymph node metastasis,and the serum level of PCNA was higher(P<0.05).After follow-up 6 months,the serum levels of PDCD5 in survival group were lower than in death group,and the serum levels of PCNA in survival group were higher than in death group(P<0.05).Multivariate Logistic analysis showed that the high serum level of PCNA,low differentiation,TNM stageⅢ-Ⅳand lymph node metastasis were independent risk factors of the survival rate of lung cancer(OR=3.157,P=0.016、OR=2.426,P=0.027),but the high serum levels of PCNA(OR=2.426,P=0.027),differentiation(OR=1.862,P=0.020),TNM stage(OR=1.726,P=0.038)and lymph node metastasis(OR=1.943,P=0.034)were protective factor to the survival rate of lung cancer(OR=0.357,P=0.016).When the cut-off point of serum PDCD5 level was 456.5 pg/ml and PCNA level was 50.8 pg/ml,the AUC of prediction to the poor prognosis in lung cancer was 0.849(P=0.030)and the sensitivity was 85.2%(95%CI:0.802~0.917)and specificity was 86.3%(95%CI:0.821~0.936).Conclusion The serum levels of PDCD5 and PCNA can be used to assess the condition and short-term prognosis of patients with lung cancer.