胃癌前病变患者病灶组织中GLDC、TRAF-4表达与内镜黏膜下剥离术后复发的关系

Relationship between GLDC and TRAF-4 expression in lesion tissues and recurrence after endoscopic submucosal dissection in patients with precancerous gastric cancer

目的探讨胃癌前病变(GPL)患者病灶组织中甘氨酸脱羧酶(GLDC)、肿瘤坏死因子受体相关因子4(TRAF-4)表达与内镜黏膜下剥离术(ESD)后复发的关系。方法选择2019年1月—2022年6月铜川市人民医院消化内科收治的GPL患者124例,均行ESD手术,取手术切除的胃癌前病变组织和病变旁组织,采用实时荧光定量聚合酶链反应(RT-PCR)法检测GLDC、TRAF-4表达,术后随访1年统计ESD术后复发情况。多因素Logistic回归分析影响GPL患者ESD术后复发的因素,受试者工作特征(ROC)曲线分析GLDC、TRAF-4预测GPL患者ESD术后复发的价值。结果GPL组织中GLDC、TRAF-4表达高于GPL旁组织(t/P=15.032/<0.001、22.256/<0.001)。随访1年,复发21例,未复发103例,复发组GPL组织中GLDC、TRAF-4表达高于未复发组GPL组织(t/P=6.368/<0.001、13.834/<0.001)。Logistic回归分析表明,切除不完整、非典型增生、高表达GLDC、高表达TRAF-4是GPL患者ESD术后复发的危险因素[OR(95%CI)=4.174(1.668~10.445)、2.593(1.227~5.483)、1.668(1.114~2.499)、1.544(1.092~2.186)];GLDC、TRAF-4及二者联合预测GPL患者ESD术后复发的曲线下面积(AUC)分别为0.830、0.810、0.933,二者联合预测的AUC高于单独预测(Z=1.953、2.599,P=0.042、0.015)。结论GPL组织中GLDC、TRAF-4高表达与ESD术后复发有关,联合GLDC、TRAF-4可预测ESD术后复发风险。

Objective To investigate the relationship between the expression of glycine decarboxylase(GLDC)and tumor necrosis factor receptor related factor 4(TRAF-4)in lesion tissues of patients with gastric pre-lesions(GPL)and the recurrence after endoscopic submucosal dissection(ESD).Methods A total of 124 GPL patients admitted to the Gastroenterology Department of Tongchuan People's Hospital from January 2019 to June 2022 were selected.The pre-cancerous tissues and adjacent tissues of gastric cancer were removed and GLDC and TRAF-4 expression were detected by real time fluorescent quantitative polymerase chain reaction(RT PCR).The postoperative recurrence of ESD was analyzed at 1 year follow up.Multivariate Logistic regression analysis was conducted to analyze the factors affecting ESD recurrence in GPL patients,and the value of GLDC and TRAF-4 in predicting ESD recurrence in GPL patients was analyzed by receiver operating characteristic(ROC)curve.Results The expressions of GLDC and TRAF-4 in GPL tissues were higher than those in adjacent GPL tissues(t/P=15.032/<0.001,22.256/<0.001),and those in relapsed GPL tissues were higher than those in non-relapsed GPL tissues(t/P=6.368/<0.001,13.834/<0.001).Incomplete resection,atypical hyperplasia,high expression of GLDC and high expression of TRAF-4 were risk factors for postoperative recurrence in GPL patients[OR(95%CI)=4.174(1.668-10.445),2.593(1.227-5.483),1.668(1.114-2.499),1.544(1.092-2.186)].The area under the curve of GLDC,TRAF-4 and combined prediction of ESD recurrence in GPL patients was 0.830,0.810 and 0.933,respectively.The area under the curve of GLDC,TRAF-4 and combined prediction of GPL patients was higher than that of single prediction(Z=1.953,2.599,P<0.05).Conclusion The high expression of GLDC and TRAF-4 in GPL tissue is associated with postoperative recurrence of ESD,and the combination of GLDC and TRAF-4 can predict the risk of postoperative recurrence of ESD.