血浆BRAF基因检测对腹腔镜右半结肠癌D3根治术中行幽门淋巴结清扫的指导价值

The value of plasma BRAF gene detection for pyloric lymph node dissection during laparoscopic D3 radical resection of right colon cancer

目的:评估血浆BRAF基因检测对腹腔镜右半结肠癌D3根治术中幽门淋巴结清扫的指导价值。方法:前瞻性选取2019年3月至2021年2月行腹腔镜右半结肠癌D3根治术的98例患者为研究对象。数据使用SPSS 25.0软件处理,计数资料以[例(%)]表示,行χ^(2)检验;正态数据使用(x±s)表示,行独立样本t检验;一致性使用Kappa系数检验;绘制ROC曲线,检验BRAD基因突变对右半结肠癌幽门下淋巴结转移以及复发的评估效能。P<0.05为差异有统计学意义。结果:98例右半结肠癌患者均顺利完成腹腔镜右半结肠癌D3根治术,45例血浆BRAF基因阳性患者行幽门下淋巴结清扫,53例血浆BRAF基因隐形患者未行幽门下淋巴结清扫。行幽门下淋巴结清扫的患者TNMⅢ期、结肠肝曲癌、近端横结肠癌以及BRAF基因突变比例高于未清扫的患者,差异有统计学意义(P<0.05);BRAF基因突变评估右半结肠癌幽门下淋巴结转移与病理诊断结果的具有较强一致性(Kappa=0.604)。ROC数据显示,BRAF基因突变评估右半结肠癌幽门下淋巴结转移的AUC为0.788。BRAF基因突变评估右半结肠癌术后复发与随访结果符合率为90.0%。ROC数据显示,BRAF基因突变评估右半结肠癌术后复发转移的AUC为0.622。结论:右半结肠癌患者BRAF基因突变通过增加幽门下淋巴结转移风险,导致术后复发转移风险增加,对于血浆BRAF基因突变的患者应考虑行幽门下淋巴结清扫。

Objective:To evaluate the value of plasma BRAF gene detection for pyloric lymph node dissection during laparoscopic D3 radical resection of right colon cancer.Methods:A total of 98 patients undergoing laparoscopic D3 radical resection of right colon cancer from March 2019 to February 2021 were prospectively selected as the study subjects.SPSS 25.0 software was used to process the data.Statistical data were presented as[cases(%)]andχ^(2) test was used.The normal data were represented by(x±s),and the inter-group comparison line independent sample t test;Consistency was tested by Kappa coefficient.ROC curve was drawn to test the efficacy of BRAD gene mutation in evaluating the metastasis and recurrence of right subpyloric lymph node of colon cancer.P<0.05 indicated that the difference was statistically significant.Results:All 98 patients with right hemicolonic carcinoma successfully completed laparoscopic D3 radical resection.45 patients with positive plasma BRAF gene received subpyloric lymph node dissection,while 53 patients with invisible plasma BRAF gene did not receive subpyloric lymph node dissection.The proportion of TNM stageⅢ,hepatocellular carcinoma,proximal transverse colon cancer and BRAF gene mutation in patients with subpyloric lymph node dissection was higher than that of patients without dissection,and the difference was statistically significant(P<0.05).BRAF gene mutation in the evaluation of right hemicolonic carcinoma subpyloric lymph node metastasis and pathological diagnosis showed a strong consistency(Kappa=0.604).ROC data showed an AUC of 0.788 for BRAF mutations evaluating subpyloric lymph node metastasis in right colon cancer.The coincidence rate between postoperative recurrence of right colon cancer assessed by BRAF mutation and follow-up was 90.0%.ROC data showed that the AUC of BRAF gene mutations evaluating postoperative recurrence and metastasis of right colon cancer was 0.628.Conclusion:BRAF gene mutation in patients with right hemicolonic carcinoma increases the risk of postoperative recurrence and metastasis by increasing the risk of subpyloric lymph node metastasis.Subpyloric lymph node dissection should be considered in patients with plasma BRAF gene mutation.