血清miR-144、miR-203对胃癌根治术患者预后的评估

Evaluation of Serum miR-144 and miR-203 on the Prognosis of Patients Undergoing Radical Gastric Cancer Surgery

目的 探讨血清微小RNA(miR)-144、miR-203对胃癌根治术患者预后的评估价值。方法 选取113例接受胃癌根治术治疗的胃癌患者为胃癌组,另选取同期66例接受内镜下切除治疗的胃息肉患者为对照组。比较两组患者血清miR-144、miR-203水平,分析血清miR-144、miR-203水平与胃癌患者临床病理特征的关系,Kaplan-Meier生存曲线分析不同血清miR-144、miR-203水平与胃癌根治术后3年累积存活率,多因素Cox回归分析胃癌根治术预后不良影响因素,ROC曲线判断血清miR-144、miR-203水平对胃癌根治术预后不良的评估价值。结果 胃癌组血清miR-144、miR-203水平低于对照组(P均<0.05)。血清miR-144、miR-203水平与胃癌患者TNM分期、分化程度、淋巴结转移有关(P均<0.05)。Kaplan-Meier生存曲线显示,高血清miR-144、miR-203水平组胃癌根治术后3年累积存活率高于低水平组(P均<0.05)。多因素Cox回归分析显示,TNM分期(HR=2.609,95%CI:1.112~6.121)、淋巴结转移(HR=2.916,95%CI:1.149~7.403)为胃癌根治术预后不良独立风险因素,miR-144(HR=0.582,95%CI:0.217~0.874)、miR-203(HR=0.603,95%CI:0.389~0.986)为独立保护因素(P<0.05)。ROC曲线显示,miR-144+miR-203评估胃癌根治术预后不良的曲线下面积(AUC)(AUC=0.922,95%CI:0.856~0.964)大于miR-144(AUC=0.826,95%CI:0.744~0.891)、miR-203(AUC=0.838,95%CI:0.757~0.901)(P均<0.05),灵敏度、特异度、准确度分别为93.10%、88.10%、89.38%。结论 胃癌患者血清miR-144、miR-203水平下调,为胃癌根治术不良预后独立保护因素,联合检测可提升不良预后评估价值。

Objective To investigate the evaluation value of serum microRNA(miR)-144 and miR-203 on the prognosis of patients undergoing radical gastric cancer surgery.Methods A total of 113 gastric cancer patients treated with radical gastrectomy were selected as the gastric cancer group,and 66 patients with gastric polyps undergoing endoscopic resection during the same period were selected as the control group.The serum miR-144 and miR-203 levels were compared between the two groups of patients,and the relationship between the serum miR-144 and miR-203 levels and the clinicopathological characteristics of patients with gastric cancer were analyzed.Kaplan-Meier survival curves were used to analyze the differences in serum miR-144 and miR-203 levels and 3-year cumulative survival rate after radical gastric cancer,multivariate Cox regression was used to analyze factors affecting the prognosis of radical gastric cancer,ROC curve was used to value the serum miR-144 and miR-203 levels in the evaluation of poor prognosis of radical gastric cancer.Results The levels of serum miR-144 and miR-203 in the gastric cancer group were significantly lower than those in the control group(P all<0.05).Serum levels of miR-144 and miR-203 were related to TNM stage,degree of differentiation and lymph node metastasis in patients with gastric cancer(P all<0.05).Kaplan-Meier survival curve showed that the 3-year cumulative survival rate after radical gastric cancer in the high serum miR-144 and miR-203 level group was significantly higher than that in the low level group(P all<0.05).Multivariate Cox regression analysis showed that TNM stage(HR=2.609,95%CI:1.112-6.121)and lymph node metastasis(HR=2.916,95%CI:1.149-7.403)were independent risk factors for poor prognosis after radical gastric cancer surgery,miR-144(HR=0.582,95%CI:0.217-0.874)and miR-203(HR=0.603,95%CI:0.389-0.986)were independent protective factors(P<0.05).The ROC curve showed that the area under the curve(AUC)of miR-144+miR-203(AUC=0.922,95%CI:0.856-0.964)for evaluating the prognosis of radical gastric cancer was significantly greater than miR-144(AUC=0.826,95%CI:0.744-0.891),miR-203(AUC=0.838,95%CI:0.757-0.901)evaluation(P all<0.05),sensitivity,specificity and accuracy were 93.10%,88.10%,89.38%.Conclusion The serum levels of miR-144 and miR-203 in patients with gastric cancer are significantly down-regulated,which are independent protective factors for the adverse prognosis of radical gastric cancer surgery.Combined detection can improve the evaluation value of adverse prognosis.