临床病理学因子及生物标记物对早期胃癌淋巴结转移的临床评估价值分析

Clinical evaluation of clinical pathological factors and biomarkers for lymph node metastasis of early gastric cancer

目的探究临床病理学因子及生物标记物对早期胃癌淋巴结转移的临床评估价值。方法选取2015年1月至2018年12月两院诊治的200例早期胃癌患者为研究对象,所有患者均接受D2胃切除手术,根据术中标本判断有无淋巴结转移,采用单因素分析与二分类Logistic回归分析临床病理学因子(siRNA等)及6种标记物(E-钙黏蛋白、α1连环蛋白、p53、KMT6/EZH2、CD44v6、PRL)与淋巴结转移的相关性;通过人胃癌细胞系CD44v6的敲除及过表达,探究其对细胞增殖、迁移及侵袭能力的影响。结果6种生物标记物中CD44v6在具有淋巴血管入侵的预测模型中具有最高的比值比(OR 4.520;95%CI 1.361-15.592),在所有标志物中,仅α1连环蛋白和CD44v6两组之间存在显著差异(P值分别为0.017和0.005);常规预测模型中包括了肿瘤大小、组织学类型、淋巴血管侵入及浸润深度等因素,新型预测模型中则包括肿瘤大小、组织学类型、淋巴血管入侵及侵袭深度与CD44v6;功能研究中则显示CD44v6可影响细胞增殖、迁移及侵袭能力。结论CD44v6的表达增加是早期胃癌淋巴结转移的重要预测因子,临床上可通过对其检测辅助确定早期胃癌的临床治疗计划。

Objective To analyze the clinical evaluation value of clinicopathological factors and biomarkers in lymph node metastasis of early gastric cancer by logistic regression.Methods from January 2015 to December 2018,200 patients with early gastric cancer were selected as the study subjects.All patients underwent D2 gastrectomy.According to the samples during the operation,whether there was lymph node metastasis was judged.Single factor analysis and binary logistic regression analysis were used to analyze the clinicopathological factors(siRNA,etc.)and six markers(E-cadherin,α1-catenin,p53,KMT6/EZH2 CD44v6,PRL)and lymph node metastasis;to explore the effect of CD44v6 on cell proliferation,migration and invasion by knockout and overexpression of human gastric cancer cell line CD44v6.Results among the six biomarkers,CD44v6 had the highest ratio(OR 5.687;95%CI 1.724-19.369)in the prediction model of lymphovascular invasion.Among all biomarkers,onlyα1-catenin and CD44v6 had significant difference(P=0.017 and 0.005 respectively).The conventional prediction model included tumor size,histological type,lymphovascular invasion and infiltration In the new model,tumor size,histological type,invasion and invasion depth of lymphatic vessels and CD44v6 were included;in the functional study,CD44v6 could affect cell proliferation,migration and invasion.Conclusion the increased expression of CD44v6 is an important predictor of lymph node metastasis in early gastric cancer.The clinical treatment plan of early gastric cancer can be determined by the detection of CD44v6.