血清趋化因子CXC配体13及趋化因子CXC受体5与老年进展期胃癌患者淋巴结转移的相关性

目的观察老年进展期胃癌患者血清趋化因子CXC配体(CXC chemokine ligand,CXCL)13、趋化因子CXC受体(CXC chemokine receptor,CXCR)5水平变化,探讨CXCL13、CXCR5与老年进展期胃癌患者淋巴结转移的关系。方法老年进展期胃癌患者89例为进展期胃癌组,其中发生淋巴结转移者38例为转移组,未发生淋巴结转移者51例为未转移组;同期诊治老年早期胃癌患者80例为早期胃癌组。采用ELISA法检测进展期胃癌组与早期胃癌组血清CXCL13、CXCR5水平,并检测进展期胃癌组血清CXCL12、CXCR4水平;比较转移组与未转移组年龄、性别比例等临床资料及血清CXCL13、CXCR5、CXCL12、CXCR4水平;多因素logistic回归分析老年进展期胃癌患者发生淋巴结转移的影响因素;绘制ROC曲线,评估血清CXCL13、CXCR5水平预测老年进展期胃癌患者淋巴结转移的价值。结果进展期胃癌组血清CXCL130.190(0.177,0.198)μg/L]、CXCR50.243(0.231,0.264)μg/L]水平均高于早期胃癌组0.176(0.167,0.184)、0.234(0.225,0.244)μg/L](P<0.05)。转移组血清CXCL13(0.203±0.052)μg/L]、CXCR5(0.279±0.085)μg/L]、CXCL12(2.03±0.53)μg/L]水平高于未转移组(0.176±0.050)、(0.223±0.080)、(1.65±0.31)μg/L],血清CXCR4(0.39±0.10)μg/L]水平低于未转移组(0.49±0.11)μg/L](P<0.05),年龄、性别比例、体质量指数、NYHA心功能分级与未转移组比较差异均无统计学意义(P>0.05)。血清CXCL13(OR=1.180,95%CI:1.085~1.296,P<0.001)、CXCR5(OR=1.302,95%CI:1.050~1.423,P=0.005)、CXCL12(OR=1.113,95%CI:1.010~1.209,P=0.008)、CXCR4(OR=1.036,95%CI:1.009~1.225,P=0.016)是老年进展期胃癌患者发生淋巴结转移的影响因素。血清CXCL13以0.165μg/L为最佳截断值,预测老年进展期胃癌患者淋巴结转移的AUC为0.820(95%CI:0.736~0.905,P<0.001),灵敏度为97.4%,特异度为51.0%;CXCR5以0.203μg/L为最佳截断值,预测老年进展期胃癌患者淋巴结转移的AUC为0.804(95%CI:0.716~0.893,P<0.001),灵敏度为94.7%,特异度为52.9%;CXCL13联合CXCR5预测老年进展期胃癌患者淋巴结转移的AUC为0.928(95%CI:0.870~0.985,P<0.001),灵敏度为97.4%,特异度为64.7%。结论老年进展期胃癌患者血清CXCL13、CXCR5水平升高,血清CXCL13、CXCR5与老年进展期胃癌患者发生淋巴结转移有关,在预测淋巴结转移发生风险中有一定价值。

Correlations of serum CXC chemokine ligand 13and CXC chemokine receptor type 5 with lymph node metastasis in elderly patients with advanced gastric cancer

Objective To observe the changes of CXC chemokine ligand 13(CXCL13)and CXC chemokine receptor type 5(CXCR5)levels in elderly patients with advanced gastric cancer,and to investigate the correlations of CXCL13and CXCR5with lymph node metastasis in elderly patients with advanced gastric cancer.Methods In 89elderly patients with advanced gastric cancer(advanced gastric cancer group),there were 38patients with lymph node metastasis(metastasis group)and 51patients without lymph node metastasis(non-metastasis group),while another 80elderly patients with early gastric cancer in the same period were as early gastric cancer group.ELISA method was used to detect the levels of serum CXCL13and CXCR5in advanced gastric cancer group and early gastric cancer group,and the serum CXCL12and CXCR4levels were detected in advanced gastric cancer group.The clinical data as the age and sex ratio as well as the serum levels of CXCL13,CXCR5,CXCL12and CXCR4were compared between metastasis and non-metastasis groups.Multivariate logistic regression analysis was used to evaluate the influencing factors of lymph node metastasis in elderly patients with advanced gastric cancer.ROC was drawn to assess the values of serum CXCL13and CXCR5levels to the prediction of lymph node metastasis in elderly patients with advanced gastric cancer.Results The levels of CXCL13and CXCR5were higher in advanced gastric cancer group(0.190(0.177,0.198),0.243(0.231,0.264)μg/L)than those in early gastric cancer group(0.176(0.167,0.184),0.234(0.225,0.244)μg/L)(P<0.05).The levels of CXCL13,CXCR5and CXCL12were higher in metastasis group((0.203±0.052),(0.279±0.085),(2.03±0.53)μg/L)than those in non-metastasis group((0.176±0.050,(0.223±0.080),(1.65±0.31)μg/L)(P<0.05),the CXCR4level was lower in metastasis group((0.39±0.10)μg/L)than that in non-metastasis group((0.49±0.11)μg/L)(P<0.05),and there were no significant differences in the age,sex ratio,body mass index and NYHA cardiac function classification between two groups(P>0.05).The serum CXCL13(OR=1.180,95%CI:1.085-1.296,P<0.001),CXCR5(OR=1.302,95%CI:1.050-1.423,P=0.005),CXCL12(OR=1.113,95%CI:1.010-1.209,P=0.008)and CXCR4(OR=1.036,95%CI:1.009-1.225,P=0.016)were the influencing factors of lymph node metastasis in elderly patients with advanced gastric cancer.When the optimal cut-off value of serum CXCL13was 0.165μg/L,the AUCfor predicting lymph node metastasis in elderly patients with advanced gastric cancer was 0.820(95%CI:0.736-0.905,P<0.001),the sensitivity was 97.4%,and the specificity was 51.0%.When the optimal cut-off value of CXCR5was 0.203μg/L,the AUCfor predicting lymph node metastasis was 0.804(95%CI:0.716-0.893,P<0.001),the sensitivity was 94.7%,and the specificity was 52.9%.The AUCof CXCL13combined with CXCR5for predicting lymph node metastasis was 0.928(95%CI:0.870-0.985,P<0.001),the sensitivity was 97.4%,and the specificity was 64.7%.Conclusion The serum CXCL13and CXCR5levels increase in elderly patients with advanced gastric cancer,and both of them are associated with lymph node metastasis and have certain values to the prediction of the risk of lymph node metastasis.