食管癌患者血清IGFBP-2的表达与营养状态及预后的关系

The expression of serum IGFBP-2 in patients with esophageal cancer and its relationship with nutritional status and prognosis

目的探讨血清胰岛素样生长因子结合蛋白-2(IGFBP-2)在食管癌患者中的表达及其与营养状态和预后的关系。方法选取行手术及放(化)疗治疗的136例食管癌患者,采用酶联免疫吸附试验(ELISA)检测患者血清IGFBP-2的表达水平,分析其与患者临床病理特征、营养相关参数的关系。通过Kaplan-Meier生存曲线评估血清IGFBP-2表达对食管癌患者总生存期(OS)的影响,采用多因素Cox回归分析IGFBP-2食管癌患者预后的影响因素。结果全组食管癌患者血清IGFBP-2水平中位数为302.52μg/L,据此分为高表达组(68例)与低表达组(68例)。与低表达组相比,高表达组患者体质量减轻≥5%(χ^(2)=6.814)、血清白蛋白<35 g/L(χ^(2)=23.702)、C反应蛋白≥10 mg/L(χ^(2)=4.561)、格拉斯哥预后评分(GPS)1~2分(χ^(2)=17.486)、预后营养指数(PNI)<50.8(χ^(2)=51.883)的比例明显升高,外周血淋巴细胞绝对值下降(均P<0.05)。生存分析显示,IGFBP-2高表达患者中位OS明显短于低表达组(22.0个月vs.36.0个月,Log-rankχ^(2)=5.037,P<0.05)。多因素Cox回归分析发现,血清IGFBP-2高表达(HR=1.631,95%CI:1.064~2.940,P=0.025)与TNM分期Ⅲ~Ⅳ期(HR=1.851,95%CI:1.166~2.940,P=0.009)是影响食管癌患者预后的独立预测因素。结论食管癌患者血清IGFBP-2表达升高提示患者营养不良,总体预后不佳。

Objective To explore the expression level of insulin-like growth factor binding protein-2(IGFBP-2)and its correlations to nutritional status and the prognosis of esophageal cancer patients.Methods cancer patients treated with surgical resection and chemotherapy/radiotherapy in our hospital were included in this study.The expression level of serum IGFBP-2 was detected by enzyme linked immunosorbent assay(ELISA),and its correlations to clinicopathological characteristics and nutritional parameters were further analyzed.Kaplan-Meier survival curve wasplotted to evaluate the impact of serum IGFBP-2 expression on the overall survival(OS)of esophageal cancer patients.Moreover,the Cox multivariate regression analysis was used to determine the prognostic significance of serum IGFBP-2 levelfor esophageal cancer patients.Results All patients were divided into the high expression(n=68)group and the lowexpression group(n=68)based on the median value(302.52μg/L)of serum IGFBP-2 expression.Compared with the lowexpression group,patients with high expression of serum IGFBP-2 had a higher proportion of weight loss≥5%(χ^(2)=6.814),serum albumin<35 g/L(χ^(2)=23.702),C-reactive protein≥10 mg/L(χ^(2)=4.561),Glasgow prognostic score(GPS)1-2(χ^(2)=17.486)and prognostic nutritional index(PNI)<50.8(χ^(2)=51.883),and a lower count of peripheral blood lymphocyte(P<0.05).Kaplan-Meier curves showed that the median OS of patients with high IGFBP-2 expression was significantly shorterthan that of patients with low IGFBP-2 expression(22.0 months vs.36.0 months,Log-rankχ^(2)=5.037,P<0.05).The resultsof multivariate Cox analysis indicated that high serum IGFBP-2 expression(HR=1.631,95%CI:1.064-2.940,P=0.025)andtumor stageⅢ-Ⅳ(HR=1.851,95%CI:1.166-2.940,P=0.009)were independent prognostic factors for esophageal cancerpatients.Conclusion The elevated serum level of IGFBP-2 expression is an indicator of malnutrition status,suggesting apoor prognosis of esophageal cancer.