早期胃癌患者血清TK1、STAT1、sB7-H4水平变化及对内镜黏膜下剥离术预后的预测价值

Changes in Serum TK1, STAT1, and sB7-H4 Levels in Early Gastric Cancer Patientsand Their Predictive Value for the Prognosis of Endoscopic Mucosal Dissection Surgery

目的 探究早期胃癌患者血清胸苷激酶1(TK1)、信号转导和转录活化因子1(STAT1)、可溶性B7-H4(sB7-H4)水平变化,并分析其对内镜黏膜下剥离术(ESD)预后的预测价值。方法 前瞻性选取2019年1月至2022年7月郑州大学第一附属医院300例接受ESD手术的早期胃癌患者,检测围手术期(术前、术后3 d、术后7 d)血清TK1、STAT1、sB7-H4水平,术后接受为期1 a随访,根据有无复发分为复发组(22例)与未复发组(278例)。比较两组患者的临床资料及血清TK1、STAT1、sB7-H4水平。评价血清TK1、STAT1、B7-H4水平预测早期胃癌患者ESD术后复发的价值。结果 所有患者术后7 d血清TK1、sB7-H4水平<术后3 d<术前(P<0.05),所有患者术后7 d血清STAT1水平>术后3 d>术前(P<0.05)。复发组术后3、7 d的血清TK1、sB7-H4水平均高于未复发组,STAT1水平均低于未复发组(P<0.05)。术后3、7 d血清TK1、sB7-H4、STAT1联合预测复发的曲线下面积(AUC)分别为0.901、0.944,均大于各时间点三项血清指标单独预测,且术后7 d预测价值更高,此时最佳敏感度、特异度分别为90.91%、86.33%。结论 血清TK1、sB7-H4、STAT1水平变化与早期胃癌患者ESD术后复发密切相关,且在临床早期预测患者术后复发方面具有较高预测效能。

Objective To investigate the changes in serum levels of thymidine kinase 1(TK1),signal transducer and activator of transcription 1(STAT1)and soluble B7-H4(sB7-H4)in patients with early gastric cancer,and analyze their prognostic value for endoscopic mucosal stripping surgery(ESD).Methods A prospective study was conducted to select 300 patients with early gastric cancer who underwent ESD surgery at the First Affiliated Hospital of Zhengzhou University from January 2019 to July 2022.The levels of serum TK1,STAT1 and sB7-H4 were measured during the perioperative period(preoperative,3 days after surgery and 7 days after surgery).The patients were followed up for 1 year after surgery and divided into a recurrence group(22 cases)and a non-recurrence group(278 cases)based on the presence or absence of recurrence.The clinical data and serum TK1,STAT1 and sB7-H4 levels of the two groups were compared.The value of serum TK1,STAT1 and sB7-H4 levels in predicting the recurrence of ESD surgery in patients with early gastric cancer was evaluated.Results The serum levels of TK1 and sB7-H4 on postoperative day 7 in all patients were lower than on postoperative day 3,and were lower than those before surgery(P<0.05).The serum levels of STAT1 in all patients on postoperative day 7 were higher than on postoperative day 3,and were higher than those before surgery(P<0.05).The serum levels of TK1 and sB7-H4 in the recurrence group were higher than those in the non-recurrence group(P<0.05).The serum levels of STAT1 in the recurrence group were lower than those in the non-recurrence group(P<0.05).The area under the curve(AUC)of serum TK1,sB7-H4 and STAT1 for predicting recurrence at postoperative day 3 and day 7 was 0.901 and 0.944,respectively,which were both higher than those of the three serum indicators alone at each time point,and the predictive value was higher on postoperative day 7,with the best sensitivity and specificity of 90.91%and 86.33%,respectively.Conclusion The changes in serum levels of TK1,sB7-H4 and STAT1 are closely related to the recurrence of early gastric cancer patients after ESD surgery,and have high predictive power for predicting the risk of postoperative recurrence in clinical early stages.