hsa_circ_0000437与危险因素对胃癌患者术后 复发的影响

目的 探究血清环状RNA hsa_circ_0000437水平与危险因素的交互作用对胃癌患者术后复发的影响。方法 选取浙江大学医学院附属第二医院临平院区2019年6月至2020年12月收治的118例胃癌患者为研究对象。根据胃癌患者术后是否复发分为复发组和未复发组。比较两组患者血清hsa_circ_0000437水平及临床资料。采用多因素Logistic回归分析影响胃癌患者术后复发危险因素及血清hsa_circ_0000437水平在两组患者间的差异，并使用相乘和相加模型进行血清hsa_circ_0000437与其他胃癌术后复发风险因素的关联强度和交互作用分析。结果 118例胃癌患者中54例患者术后复发，术后复发率为45.76%。复发组患者病理分化程度、合并症种类、浆膜浸润、淋巴结数目、淋巴结清扫范围分布与未复发组差异有统计学意义（P<0.05）；复发组肿瘤直径大于未复发组（P<0.05）；血清hsa_circ_0000437水平高于未复发组（P<0.05）。Logistic回归分析显示，肿瘤直径（大）、病理分化程度（低）、浆膜浸润（有）及血清hsa_circ_0000437水平（高）均是影响胃癌患者术后复发的危险因素（P<0.05）。交互作用分析结果显示，血清hsa_circ_0000437（高）和肿瘤直径（大）对胃癌患者术后复发具有相加交互作用（OR=11.144，95%CI：2.257～18.145），超额危险度（excess relative risk，RERI）=5.844，95%CI：1.264～11.357，交互作用归因比（attributable proportion due to interaction，AP）=0.524，95%CI：0.236～0.891，交互作用指数（interaction index，S）=2.359，95%CI：1.024～6.577。血清hsa_circ_0000437（高）和病理分化程度（低）对胃癌患者术后复发具有相加交互作用（OR=7.083，95%CI：4.372～13.159；RERI=2.841，95%CI：1.152～6.339；AP=0.351，95%CI：0.188～0.754；S=1.670，95%CI：1.006～4.351）。血清hsa_circ_0000437（高）与浆膜浸润对胃癌患者术后复发具有相加交互作用（OR=7.157，95%CI：3.759～12.046；RERI=4.067，95%CI：1.378～9.466；AP=0.568，95%CI：0.221～0.961；S=2.947，95%CI：1.128～8.319）。结论 血清hsa_circ_0000437水平（高）与肿瘤直径（大）、病理分化程度（低）、浆膜浸润（有）对胃癌患者术后复发具有相加交互作用。

Effect of hsa_circ_0000437 and risk factors on postoperative recurrence in patients with gastric cancer

Objective To explore the effect of interaction between serum circular RNA hsa_circ_0000437 level and risk factors on postoperative recurrence in patients with gastric cancer. Methods A total of 118 patients with gastric cancer admitted to Linping District, the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2019 to December 2020 were selected as the study objects. Patients with gastric cancer were divided into recurrence group and non-recurrence group according to whether they had recurrence after operation. The serum hsa_circ_0000437 level and clinical data of the two groups were compared. Multivariate Logistic regression analysis was used to analyze the risk factors affecting postoperative recurrence in patients with gastric cancer and the differences in serum hsa_circ_0000437 levels between the two groups, and the correlation strength and interaction between serum hsa_circ_0000437 and other risk factors for postoperative recurrence of gastric cancer were performed using the multiplicative and additive models. Results A total of 54 of 118 patients with gastric cancer recurred after operation, and the recurrence rate was 45.76%. There were significant differences between the recurrence group and the non-recurrence group in the degree of pathological differentiation, types of complications, serous infiltration, number of lymph nodes and distribution of lymph node dissection (P<0.05). The tumor diameter of recurrent group was higher than that of non-recurrent group (P<0.05). The serum hsa_circ_0000437 level was higher than that of the non-recurrence group (P<0.05). Logistic regression analysis showed that tumor diameter (large), pathological differentiation degree (low), serous membrane infiltration (present) and serum hsa_circ_0000437 level (high) were all risk factors for postoperative recurrence in gastric cancer patients (P<0.05). Interaction analysis results showed that serum hsa_circ_0000437 (high) and tumor diameter (large) had additive interaction on postoperative recurrence in patients with gastric cancer (OR=11.144, 95%CI: 2.257?18.145), excess relative risk (RERI)=5.844, 95%CI: 1.264?11.357, attributable proportion due to interaction (AP) =0.524, 95%CI: 0.236?0.891, interaction index (S)=2.359, 95%CI: 1.024?6.577. Serum hsa_circ_0000437 (high) and pathological differentiation (low) had additive interaction on postoperative recurrence of gastric cancer patients (OR=7.083, 95%CI: 4.372?13.159; RERI=2.841, 95%CI: 1.152?6.339; AP=0.351, 95%CI: 0.188?0.754; S=1.670, 95%CI: 1.006?4.351). Serum hsa_circ_0000437 (high) and serous infiltration had a summative interaction on postoperative recurrence in patients with gastric cancer (OR=7.157, 95%CI: 3.759?12.046; RERI=4.067, 95%CI: 1.378?9.466; AP=0.568, 95%CI: 0.221?0.961; S=2.947, 95%CI: 1.128?8.319). Conclusion Serum hsa_circ_0000437 level (high) has additive interaction with tumor diameter (large), pathological differentiation degree (low) and serous membrane infiltration (present) on postoperative recurrence of gastric cancer patients.