摘要
背景胃癌淋巴结转移是癌症研究领域重点,当前影像学手段及传统肿瘤标志物诊断效果有限,需探索更为新型、无创血清学标志物.目的探讨基于人类软骨糖蛋白-39(human cartilage glyco-protein-39,YKL-40)、糖类抗原50(carcinoma antigen50,CA50)、铁蛋白(serum ferritin,SF)的胃癌淋巴结转移列线图诊断模型构建.方法收集2020-01/2023-12磐安县人民医院收治的120例胃癌患者临床资料进行回顾性分析,根据术后病理结果分为转移组和非转移组,比较两组临床资料、血清YKL-40、CA50、SF表达,采用Lasso-Logistic回归方程筛选胃癌淋巴结转移影响因素,采用R软件构建诺莫图诊断模型,绘制受试者工作特征曲线及曲线下面积(areaunder the roc curve,AUC)、校准曲线、决策曲线分析含与不含YKL-40、CA50、SF的诺莫图模型区分度、校准度、临床净收益.结果(1)病理检查结果显示,120例胃癌淋巴结转移发生率为25.77%;(2)Lasso-Logistic回归方程显示,YKL-40(OR:2.190)、CA50(OR:3.173)、SF(OR:3.879)、脉管侵犯(OR:3.039)、TNM分期(OR:4.854)、淋巴结清扫范围(OR:3.855)是胃癌淋巴结转移的影响因素(P<0.05);(3)根据胃癌淋巴结转移影响因素绘制诺莫图诊断模型,其AUC为0.880(95%CI:0.811-0.949)校准曲线与45°参考线大致重合,在25%-75%范围内可提供附加临床获益.结论基于YKL-40、CA50、SF的诺莫图诊断模型在胃癌淋巴结转移诊断中表现出良好性能,有助于指导临床诊治,促进疾病转归.
BACKGROUND Currently,the diagnostic efficacy of imaging techniques and traditional tumor markers for lymph node metastasis in gastric cancer is limited,necessitating the exploration of more innovative and non-invasive serological markers.AIM To construct a diagnostic model for lymph node metastasis in gastric cancer based on human cartilage glycoprotein-39(YKL-40),carbohydrate antigen 50(CA50),and serum ferritin(SF).METHODS A retrospective analysis was conducted on the clinical data of 120 gastric cancer patients admitted to Pan’an County People’s Hospital from January 2020 to December 2023.The patients were divided into a metastatic group and a non-metastatic group based on postoperative pathological results.Clinical data,serum YKL-40,CA50,and SF were compared between the two groups.Lasso Logistic regression equation was used to screen for factors affecting gastric cancer lymph node metastasis.R software was used to construct a diagnostic nomogram model,and receiver operating characteristic curve,area under the curve(AUC),calibration curve,and decision curve analyses were performed to evaluate whether YKL-40 and CA50 were included or not,as well as the discrimination,calibration,and clinical net benefit of the nomogram model.RESULTS Pathological examination results showed that the inci-dence of lymph node metastasis in 120 cases of gastric cancer was 25.77%.The Lasso-Logistic regression equation showed that YKL-40(odds ratio[OR]:2.190),CA50(OR:3.173),SF(OR:3.879),vascular invasion(OR:3.039),TNM stage(OR:4.854),and extent of lymph node dissection(OR:3.855)were influencing factors of lymph node metastasis in gastric cancer(P<0.05).Based on these influencing factors,a diagnostic nomogram model was drawn,with an AUC of 0.880(95%confidence interval:0.811-0.949).The calibration curve roughly coincided with the 45°reference line,providing additional clinical benefit within the range of 25%to 75%.CONCLUSION The diagnostic nomogram model based on YKL-40,CA50,and SF shows good performance in diagnosing lymph node metastasis in gastric cancer,which is helpful in guiding clinical diagnosis and treatment,and improving disease outcomes.
作者
胡秀珍
黄东标
倪伟平
潜晓霞
Xiu-Zhen Hu;Dong-Biao Huang;Wei-Ping Ni;Xiao-Xia Qian(Department of Laboratory Medicine,Pan’an County People’s Hospital,Jinhua 322300,Zhejiang Province,China)
出处
《世界华人消化杂志》
CAS
2024年第10期774-781,共8页
World Chinese Journal of Digestology
关键词
胃癌
淋巴结转移
前列腺特异抗原
糖类抗原50
铁蛋白
Gastric cancer
Lymph node metastasis
Prostate specific antigen
Carbohydrate antigen 50
Ferritin
