DIAPH3在胰腺癌组织中的表达及其对预后的预测价值

Expression of DIAPH3 in pancreatic carcinoma tissues and its prognostic prediction value

目的 探讨细胞骨架调节蛋白3(DIAPH3)在胰腺癌组织中的表达及其对患者预后的预测价值。方法 选择2017年3月至2022年3月于徐州医科大学附属淮安医院接受胰腺癌根治术治疗的68例胰腺癌患者纳入研究,收集手术切除的新鲜胰腺癌组织及癌旁组织(距离肿瘤组织边缘>5 cm)。采用免疫组织化学染色法(SP法)检测组织中DIAPH3的表达水平,并分析胰腺癌组织中DIAPH3的表达与患者临床病理特征的关系。采用Cox比例风险回归模型分析探讨胰腺癌患者预后的影响因素。自手术日起对入组患者进行为期1年的随访,采用KaplanMeier法绘制生存曲线,以Log-rank检验分析胰腺癌组织中DIAPH3的表达与患者术后1年生存率的关系。采用ROC曲线分析DIAPH3对胰腺癌患者术后1年生存率的预测价值。结果 胰腺癌组织中DIAPH3的阳性表达率显著高于癌旁组织(55.88%比14.71%),差异具有统计学意义(χ^(2)=25.242,P=0.000)。肿瘤最大径≥3 cm、有淋巴结转移、低分化、TNM分期为Ⅲ~Ⅳ期、肿瘤位于胰体/尾部、糖抗原19-9(CA19-9)>37 kU/L者的胰腺癌组织中DIAPH3的阳性表达率分别高于肿瘤最大径<3 cm、无淋巴结转移、中高分化、TNM分期为Ⅰ~Ⅱ期、肿瘤位于胰头部、CA19-9≤37 kU/L者,组间差异均有统计学意义(P均<0.05)。多因素Cox比例风险回归模型分析结果显示,肿瘤最大径、分化程度、CA19-9、DIAPH3均是胰腺癌患者术后1年生存率的独立危险因素(P均<0.05)。DIAPH3阳性表达组的术后1年生存率低于阴性表达组(55.26%比80.00%),平均生存时间短于阴性表达组[(164.32±18.53)d比(241.54±19.28)d],差异均有统计学意义(P均<0.05)。ROC曲线分析结果显示,胰腺癌组织中DIAPH3预测患者术后1年生存率的曲线下面积(AUC)为0.768(95%CI:0.612~0.935),敏感度为82.95%,特异度为63.21%。结论 胰腺癌组织中DIAPH3呈高表达,其可能参与了胰腺癌的发生和进展过程,可作为预测患者术后1年生存率的重要参考指标。

Objective This paper intends to investigate the expression of diaphanous related formin 3(DIAPH3)in pancreatic carcinoma tissues and its prognostic prediction value.Methods A total of 68 patients with pancreatic cancer who underwent radical surgery in the Affiliated Huai'an Hospital of Xuzhou Medical University from March 2017 to March 2022 were selected in the study,and the fresh pancreatic carcinoma tissues and paracancerous tissues(>5 cm away from the tumor tissue margin)were collected.The expression of DIAPH3 in pancreatic carcinoma tissues was detected by immunohistochemical staining(SP method),and the relationship between the expression of DIAPH3 in pancreatic carcinoma tissues and the clinicopathological features of patients was analyzed. The Cox proportional hazards regressionmodel was used to analyze the prognostic factors of pancreatic cancer patients. All patients were followedup for one year from the day of operation. A survival curve was plotted by using the Kaplan-Meier methodand a Log-rank test was conducted to compare the 1-year survival rate in patients with DIAPH3 expressionin pancreatic cancer. The receiver operating characteristic (ROC) curve was drawn to analyze the predictivevalue of DIAPH3 on the one-year survival rate of pancreatic cancer patients. Results The positiveexpression rate of DIAPH3 in pancreatic carcinoma tissues is significantly higher than that in paracanceroustissues (55.88% versus 14.71%), with a statistically significant difference (χ^(2)=25.242 and P=0.000). Thepositive expression rate of DIAPH3 in pancreatic carcinoma tissues with tumor maximum diameter≥3 cm,lymph node metastasis, poor differentiation, TNM stage Ⅲ-Ⅳ, tumor located in the body/tail of the pancreas,CA19-9>37 kU/L are higher than those with tumor maximum diameter<3 cm, no lymph node metastasis,medium and high differentiation, TNM stage Ⅰ-Ⅱ, tumor located in the head of the pancreas, CA19-9≤37 kU/L, with statistically significant differences (P<0.05). The multivariate Cox regression model analysisshows that the largest tumor diameter, differentiation degree, CA19-9, DIAPH3 are independent risk factorsfor one-year survival rate of patients with pancreatic cancer (P<0.05). The one-year survival rate of theDIAPH3 positive expression group is lower than that of the negative expression group (55.26% versus80.00%), and the average survival time is shorter than that of the negative expression group (164.32±18.53 dversus 241.54±19.28 d), with statistically significant differences (P<0.05). The ROC curve analysisindicates that the area under the curve (AUC) of DIAPH3 in pancreatic carcinoma tissues predicting oneyearsurvival rate of patients is 0.768 (95%CI: 0.612-0.935), the sensitivity is 82.95%, and the specificity is63.21%. Conclusion DIAPH3 is highly expressed in pancreatic carcinoma tissue, which may participate inthe occurrence and progression of pancreatic cancer and become an important reference index to predict theone-year survival rate of patients after surgery.