血清Kisspeptin-1对甲状腺癌诊断和预后的临床意义

Clinical significance of serum kisspeptin-1 in the diagnosis and prognosis of thyroid cancer

目的探讨血清人吻合素-1(Kisspeptin-1,KISS-1)对甲状腺癌诊断和预后的临床意义。方法采用回顾性研究方法收集2019年2月至2021年2月进行甲状腺手术切除的105例甲状腺癌患者,并选取70例甲状腺良性病变者作为甲状腺良性病变组和82例健康志愿者作为健康对照组。比较2组血清KISS-1水平,利用受试者工作曲线(ROC)评价血清KISS-1对甲状腺癌的诊断效能,单因素分析血清KISS-1与临床资料的关系;Cox比例风险模型甲状腺癌生存的独立影响因素。结果甲状腺癌组血清KISS-1水平为(1.30±0.41)pg/ml,甲状腺良性病变组为(1.77±0.51)pg/ml,健康对照组为(2.22±0.53)pg/ml,甲状腺癌组血清KISS-1水平显著高于甲状腺良性病变组和对照组(t=13.358,5.297,P<0.001)。血清KISS-1诊断甲状腺癌的AUC为0.908,敏感性和特异性为90.48%和82.93%;血清KISS-1甲状腺良性病变者和健康对照组的AUC为0.732,敏感性和特异性为85.71%和54.88%。发生颈部淋巴结转移患者显著低于无淋巴转移患者,肿瘤直径≥3 cm患者血清KISS-1水平明显低于肿瘤直径﹤3 cm患者,Ⅲ~Ⅳ患者血清KISS-1水平显著低于Ⅰ~Ⅱ患者,中、高分化患者血清KISS-1水平明显低于低分化患者(P<0.05);血清KISS-1低水平组5年生存率69.8%明显低于高水平组86.5%,差异有统计学意义(χ^(2)=4.293,P=0.038);多因素Cox回归显示,血清KISS-1降低(<1.29 pg/ml)、颈部淋巴结转移及分化程度是甲状腺癌不良预后的独立预后因素(均P<0.05)。结论甲状腺癌患者血清KISS-1表达水平降低,血清KISS-1水平越低,患者预后越差,血清KISS-1可以作为甲状腺癌诊断及预后评估的指标之一。

Objective To investigate the clinical significance of serum kisspeptin-1(KISS-1)in the diagnosis and prognosis of thyroid cancer.Methods The clinical data of 105 surgically treated patients with thyroid canceRwho were hospitalized in the Endocrinology Department of Hospital were retrospectively analyzed.During the same period,seventy patients benign thyroid diseases and 82 healthy volunteers were selected in the benign thyroid disease group and healthy control group.Serum KISS-1 level of each group was detected by enzyme-linked immunosorbent assay(ELISA).The diagnostic efficacy of serum KISS-1 on thyroid canceRwas evaluated by plotting the receiveRoperating characteristic(ROC)curves.The correlation of gender,age,pathological type,tumoRsize,cervical lymph node metastasis,differentiation degree,and TNM staging of patients with thyroid canceRwith serum level of KISS-1 was analyzed.The risk factors affecting the prognosis of patients with thyroid canceRwere analyzed by the Cox proportional hazard model.Results Serum KISS-1 level in the thyroid canceRgroup,benign thyroid disease group and healthy control group was(1.30±0.41)pg/mL,(1.77±0.51)pg/mL,and(2.22±0.53)pg/mL,respectively.It was significantly higheRin the thyroid canceRgroup than that in the benign thyroid disease group and the control group(t=13.358 and 5.297,respectively;P<0.001).The area undeRthe curve(AUC)of serum KISS-1 in the diagnosis of thyroid canceRwas 0.908,with the sensitivity and specificity of 90.48%and 82.93%,respectively.The AUC of serum KISS-1 patients in discriminating benign thyroid lesions was 0.732,with the sensitivity and specificity of 85.71%and 54.88%,respectively.Serum KISS-1 level of patients with cervical lymph node metastasis,tumoRsize≥3cm,stageⅢ-Ⅳand moderately and well differentiated was significantly loweRthan those without lymph node metastasis,tumoRsize<3cm,stageⅠ-Ⅱand poorly differentiated(P<0.05).The 5-yeaRsurvival of thyroid canceRpatients with low serum levels of KISS-1 was significantly loweRthan those with high levels(69.8%vs 86.5%,χ^(2)=4.293,P=0.038).Multivariate Cox regression showed that the decrease of serum KISS-1(<1.29pg/ml),cervical lymph node metastasis and differentiation degree were independent risk factors foRpooRprognosis of thyroid cancer(P<0.05).Conclusion Serum KISS-1 decreases in patients with thyroid cancer.The loweRserum level of KISS-1 predicts a worse prognosis of thyroid cancer.Serum KISS-1 can be used as one of the indicators foRthe diagnosis and prognosis of thyroid cancer.