胃癌患者血清外泌体粒径的临床意义

Serum exosome particle size as a biomarker for evaluating prognosis in patients with gastric cancer

目的探讨胃癌患者血清外泌体粒径的变化及其在胃癌患者预后评估方面的临床意义。方法收集2021年5月至2022年2月皖南医学院收治的胃癌病例,同时收集同期健康体检者作为对照组。采用PEG沉淀法提取32例胃癌患者及26例健康志愿者的血清外泌体,运用纳米颗粒跟踪技术(NTA)检测胃癌血清外泌体的粒径和浓度;分析血清外泌体粒径大小与胃癌临床病理特征的关系;采用受试者工作特征曲线(ROC)分析血清外泌体粒径和浓度检测对胃癌分期的预测价值。结果胃癌患者血清外泌体的浓度为(9.53±6.24)×10^(7)particals/ml,高于健康对照组的(6.14±3.43)×10^(7)particals/ml,差异有统计学意义(P<0.05);且胃癌患者血清外泌体粒径为(108.35±16.63)nm,显著小于健康对照组的(128.23±20.24)nm,差异有统计学意义(P<0.001)。血清外泌体粒径与胃癌患者的分期相关,即随着胃癌分期的增加,血清外泌体的粒径显著下降(P<0.05);ROC曲线结果显示,血清外泌体粒径诊断胃癌的灵敏度、特异度分别为55.56%、92.86%,AUC为0.7579;血清外泌体粒径与血清肿瘤标记物联合诊断胃癌的AUC为0.8413,显著优于单一血清肿瘤标记物(CEA、AFP、CA199)的检测,将其灵敏度由38.89%升高至66.67%。结论胃癌患者血清中外泌体粒径的改变与胃癌的进展相关,有望成为胃癌诊断与预后评估的潜在标志物。

Objective To investigate the relationship between serum exosome particle size and the prognosis of gastric cancer.Methods A total of 32 patients diagnosed with gastric cancer in the First Affiliated Hospital of Wannan Medical College from May 2021 to February 2022 were collected as the gastric cancer group,and 26 healthy individuals were selected as the control group.Serum exosome was isolated and extracted by polyethylene glycol(PEG)precipitation.We measured particle size and concentration of gastric cancer serum exosomes by nanoparticle tracking technology(NTA).The relationship of serum exosome particle size with clini-copatholigical characteristics and prognosis of gastric cancer was analyzed.The receiver operating characteristic(ROC)curve was drawn to analyze the value of serum exosome particle size and concentration in assessing the prognosis of gastric cancer patients.Results The concentration of serum exosome in gastric cancer patients was(9.53±6.24)×10^(7) particles/ml,which was higher than(6.14±3.43)×10^(7) particles/ml of the healthy control group(P<0.05),but their particle size was(108.35±16.63)nm,which was significantly less than(128.23±20.24)nm of the healthy control group(P<0.001).Moreover,the particle size of serum exosome was related to tumor pathologic-tumor-node-metastasis(pTNM)stages and clinical tumor-node-metastasis(cTNM)stage.As the staging of gastric cancer increasesd,the particle size of serum exosome significantly decreasesd(P<0.05).ROC curve showed that the area under the curve(AUC)for exosome particle size was 0.7579,with sensitivity and specificity of 55.56%and 92.86%.Further analysis demonstrated that the AUC for combined detection of exosome particle size,CEA,AFP and CA199 was 0.8413,and the sensitivity were 66.67%.Conclusion Dcreased exosome size is related to the poor prognosis of gastric cancer.Combined detection of serum exsome size,CEA,AFP and CA199 is expected to be a potential index for the diagnosis and prognosis of gastric cancer.