血清外泌体miRNAs在晚期胃癌患者化疗疗效预测中的价值

  目的  通过筛选晚期胃癌患者血清外泌体miRNAs，探讨外泌体miRNAs在化疗疗效预测中的价值。  方法  收集苏州大学附属第一医院2018年4月至2020年11月确诊为初治Ⅳ期胃腺癌患者36例病例资料，均接受不少于2个周期的Xelox或SOX方案化疗，根据实体肿瘤疗效评价标准（RECIST标准）分为敏感组和耐药组，收集患者首次化疗前的血清标本，提取血清外泌体RNA，行miRNAs测序，筛选出差异表达显著的miRNAs，并采用实时荧光定量PCR对筛选的miRNAs进行验证，使用受试者工作特征曲线（receiver operating characteristic curve，ROC），判断验证后的外泌体miRNAs在疗效预测中的价值。  结果  36例Ⅳ期胃癌患者按照RECIST标准，分为敏感组15例，耐药组21例。两组患者血清外泌体中共筛选出527个差异表达的miRNAs，经qRT-PCR验证后，仅3个外泌体miRNAs差异具有统计学意义，ROC曲线预测miRNA-106a-5p、miRNA-1323、miRNA-202-3p与胃癌化疗疗效的曲线下面积分别为0.952、0.949、0.946，灵敏度分别为90.5%、90.1%、85.7%，特异度分别为:93.3%、86.7%、93.1%。  结论  检测晚期胃癌患者血清外泌体miRNA-106a-5p、miRNA-1323、miRNA-202-3p，可能对化疗疗效具有一定的预测价值。 

Value of serum exosomal miRNAs in predicting the efficacy of chemotherapy in patients with advanced gastric cancer

  Objective  To investigate the value of exosomal miRNAs in predicting the efficacy of chemotherapy in patients with advanced gastric cancer.   Methods  Overall, 36 patients with stage Ⅳgastric adenocarcinoma at The First Affiliated Hospital of Soochow University between April 2018 and November 2020 were included and administered at least two cycles of Xelox or SOX chemotherapy. According to the RECIST criteria, patients were assigned into the sensitive group and resistant group. Serum samples before the first chemotherapy were collected, and serum exosomal RNA was extracted. miRNA sequencing was performed, and miRNAs with significant differential expression were included. Polymerase chain reaction (PCR) was used to verify the screened miRNAs. Receiver operating characteristic curve (ROC) analysis was used to determine the value of the validated exosomal miRNAs for efficacy prediction.   Results  The drug-sensitive group had 15 patients, and the drug-resistant group had 21 patients. Overall, 527 differentially expressed miRNAs were included, and only three exosomal miRNAs were significant after qRT-PCR verification. Areas under the ROC curve of miRNA-106a-5p, miRNA-1323, and miRNA-202-3p for predicting fluorouracil’s efficacy were 0.952, 0.949, and 0.946, respectively. The sensitivity was 90.5%, 90.1%, and 85.7%, and the specificity was 93.3%, 86.7%, and 93.1%, respectively.   Conclusions  Detection of serum exosomal miRNA-106a-5p, miRNA-1323, and miRNA-202-3p in patients with advanced gastric cancer may have a certain predictive value for the efficacy of chemotherapy.