血清SCC-Ag、VEGF、UHRF1水平联合预测食管鳞癌根治术后复发的价值

Value of Serum SCC-Ag,VEGF and UHRF1 Levels in Combined Predicting the Recurrence of Esophageal Squamous Cell Carcinoma After Radical Resection

目的探讨血清人鳞状细胞癌相关抗原(SCC-Ag)、血管内皮生长因子(VEGF)、环指域1(UHRF1)水平联合预测食管鳞癌根治术后复发的价值。方法回顾性分析2017年5月至2019年6月因食管鳞癌于郑州大学第一附属医院接受根治术治疗的116例患者的临床资料。术前均检测血清SCC-Ag、VEGF、UHRF1水平,比较不同临床病理特征患者各血清指标。术后均随访3 a,根据是否复发将患者分为复发组(56例)和未复发组(60例),并比较两组血清SCC-Ag、VEGF、UHRF1水平和临床病理特征。采用Cox回归模型分析食管鳞癌根治术后复发的危险因素,并绘制受试者工作特征(ROC)曲线分析血清SCC-Ag、VEGF、UHRF1水平联合对食管鳞癌根治术后复发的预测价值。结果最大肿瘤直径>5 cm、有淋巴结转移、TNM分期Ⅲ期、低分化程度患者血清SCC-Ag、VEGF、UHRF1水平均高于最大肿瘤直径≤5 cm、无淋巴结转移、TNM分期Ⅰ~Ⅱ期、高/中分化程度患者(P<0.05);复发组血清SCC-Ag、VEGF、UHRF1水平和最大肿瘤直径>5 cm、有淋巴结转移、TNM分期Ⅲ期、低分化程度占比均高于未复发组(P<0.05);Cox回归模型分析结果显示,在未校正因素时,血清SCC-Ag、VEGF、UHRF1水平均是食管鳞癌患者根治术后3 a内复发的危险因素(RR=2.978、3.031、3.126,P<0.05),校正性别、年龄、肿瘤部位、最大肿瘤直径、淋巴结转移、TNM分期、分化程度后仍是术后3 a内复发的危险因素(RR=1.939、2.112、2.235,P<0.05);ROC曲线分析结果显示,血清SCC-Ag、VEGF、UHRF1水平联合预测食管鳞癌根治术后复发的灵敏度和曲线下面积(AUC)分别为94.64%、0.919,均高于各指标单独预测(P<0.05),其特异度与各指标单独预测比较差异无统计学意义(P>0.05)。结论血清SCC-Ag、VEGF、UHRF1水平与食管鳞癌患者临床病理特征和术后复发均具有一定的相关性,对术后复发均具有预测价值,但三者联合预测价值更高。

Objective To investigate the value of serum levels of human squamous cell carcinoma associated antigen(SCC-Ag),vascular endothelial growth factor(VEGF)and ring finger domain 1(UHRF1)in combined predicting the recurrence of esophageal squamous cell carcinoma after radical resection.Methods The clinical data of 116 patients with esophageal squamous cell carcinoma who received radical surgery in the First Affiliated Hospital of Zhengzhou University from May 2017 to June 2019 were analyzed retrospectively.The serum SCC-Ag,VEGF and UHRF1 levels were detected before operation,and serum indexes of patients with different clinicopathological characteristics were compared.All patients were followed up for 3 years,and the patients were divided into relapse group(56 cases)and non relapse group(60 cases)according to whether recurrence,and the serum SCC-Ag,VEGF,UHRF1 levels and clinicopathological characteristics of the two groups were compared.Cox regression model was used to analyze the risk factors of recurrence of esophageal squamous cell carcinoma after radical resection,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum SCC-Ag,VEGF,UHRF1 levels on recurrence of esophageal squamous cell carcinoma after radical resection.Results The levels of serum SCC-Ag,VEGF and UHRF1 in patients with the largest tumor diameter>5 cm,lymph node metastasis,TNM stageⅢ,low differentiation were higher than those in patients with the largest tumor diameter≤5 cm,no lymph node metastasis,TNM stageⅠ~Ⅱand high/medium differentiation(P<0.05).The levels of serum SCC-Ag,VEGF and UHRF1 and the proportions of maximum tumor diameter>5 cm,lymph node metastasis,TNM stageⅢand low differentiation in the relapse group were higher than those in the non relapse group(P<0.05).Cox regression model analysis results showed that,when the factors were not adjusted,the serum SCC-Ag,VEGF and UHRF1 levels were all risk factors for recurrence of esophageal squamous cell carcinoma patients within 3 years after radical surgery(RR=2.978,3.031,3.126,P<0.05),and adjusted for gender,age,tumor location,maximum tumor diameter,lymph node metastasis,TNM stage,degree of differentiation,they were still risk factors for recurrence within 3 years after operation(RR=1.939,2.112,2.235,P<0.05).The results of ROC curve analysis showed that the sensitivity and area under curve(AUC)of serum SCC-Ag,VEGF and UHRF1 levels to combined predict the recurrence of esophageal squamous cell carcinoma after radical resection were 94.64%and 0.919 respectively,which were higher than those predicted by each index alone(P<0.05),and the specificity was not statistically significant compared with those predicted by each index alone(P>0.05).Conclusion Serum SCC-Ag,VEGF and UHRF1 levels have a certain correlation with the clinicopathological characteristics and postoperative recurrence of esophageal squamous cell carcinoma patients,and all of them have predictive value for postoperative recurrence,but their combined predictive value is higher.