血清细胞角质素片段19在胃癌患者中的表达及对HER-2阳性的预测能力

张旭; 南京柱; 栾小娟; 张庆

doi:10.3969/j.issn.2095-5227.2023.05.010

血清细胞角质素片段19在胃癌患者中的表达及对HER-2阳性的预测能力

Expression of serum keratin fragment 19 in patients with gastric cancer and its predictive power for positive HER-2

摘要

摘要:
背景 HER-2阳性的胃癌患者预后较差，且缺少与胃癌HER-2阳性相关肿瘤标志物的报道。
目的探讨血清CYFRA21-1表达水平与HER-2阳性胃癌患者的相关性。
方法收集2019年1月 - 2021年12月在解放军总医院手术治疗的胃癌患者165例，其中男115例，女50例，年龄29 ~ 82岁。分析HER-2基因表达阳性患者的CYFRA21-1水平，并绘制CYFRA21-1在HER-2阳性患者中表达的ROC曲线，分析其预测HER-2阳性胃癌的阈值。
结果血清CYFRA21-1水平与胃癌的病理组织学分化程度和分型、TNM分期及肿瘤大小有关(P＜0.05）；HER-2阳性组中CYFRA21-1水平显著高于阴性组(P=0.038)；CYFRA21-1阳性表达在HER-2阳性组中的OR值为3.529(95% CI：0.967 ~ 12.878)，对HER-2阳性胃癌患者的预测百分比为70.4%，当CYFRA21-1的Cut-off值为3.62 ng/mL时，对胃癌患者HER-2阳性的预测敏感度和特异度达到最高，分别为0.552和0.833。CYFRA21-1＜3.62 ng/mL的胃癌患者1年、2年、3年生存率高于CYFRA21-1＞3.62 ng/mL者(P=0.002)，HER-2阴性胃癌患者1年、2年、3年生存率高于阳性者(P=0.044)。
结论 HER-2基因及血清CYFRA21-1水平在胃癌转移、肿瘤较大、TNM分期较晚的患者中表达升高。CYFRA21-1水平较高、HER-2阳性者生存预后较差。高血清CYFRA21-1水平对胃癌患者HER-2基因阳性表达有一定的预测价值。

Abstract:
Background The prognosis of gastric cancer patients with positive HER-2 is poor, and there is a lack of reports on tumor markers related to positive HER-2 in gastric cancer.
Objective To investigate the correlation between serum CYFRA21-1 expression and HER-2 positive gastric cancer patients.
Methods From January 2019 to December 2021, 165 gastric cancer patients, including 115 males and 50 females, aged from 29 to 82 years, were enrolled in this study. The CYFRA21-1 level of patients with positive HER-2 gene expression was analyzed. The ROC curve of CYFRA21-1 expression in HER-2 positive patients was drawn to analyze the threshold of predicting HER-2 positive gastric cancer.
Results Serum CYFRA21-1 level was correlated with histopathological differentiation and classification of gastric cancer, TNM stage and tumor size (P<0.05). The level of CYFRA21-1 in HER-2 positive group was significantly higher than that in negative group (P=0.038). The OR value of CYFRA21-1 in the positive HER-2 group was 3.529 (0.967-12.878), and the prediction percentage of positive HER-2 gastric cancer patients was 70.4%. When the cutoff value of CYFRA21-1 was 3.60 ng/mL, the sensitivity and specificity of positive HER-2 prediction in gastric cancer patients would reach the highest, which were 0.552 and 0.833, respectively. The 1-year, 2-year and 3-year survival rates of gastric cancer patients with CYFRA21-1<3.62 ng/mL were higher than those with CYFRA21-1>3.62 ng/mL (P=0.0024). The 1-year, 2-year and 3-year survival rates of HER-2 negative gastric cancer patients were higher than those of positive patients (P=0.0442).
Conclusion The expression levels of HER-2 gene and sera CYFRA21-1 increase in patients with gastric cancer metastasis, large tumor and late TNM stage. The survival prognosis of patients with high CYFRA21-1 level and positive HER-2 is poor. High sera CYFRA21-1 level has a good warning effect on positive HER-2 gene in gastric cancer patients.

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