非小细胞肺癌微波消融术后血清Caspase-4变化及意义

目的探讨非小细胞肺癌(NSCLC)患者微波消融术后血清半胱天冬酶(Caspase-4)变化及意义。 方法选择2013年3月至2016年1月我院及省肿瘤医院收治的159例NSCLC患者作为研究对象，所有患者均接受微波消融治疗。采用活性荧光法测定检测NSCLC患者微波消融治疗前后血清Caspase-4水平。比较不同预后NSCLC患者血清Caspase-4水平。采用受试者工作特征(ROC)曲线分析血清Caspase-4评估NSCLC患者预后的价值。比较不同血清Caspase-4水平NSCLC患者平均生存时间，并采用Cox单因素及多因素分析影响NSCLC患者预后的相关因素。 结果NSCLC患者微波消融术后血清Caspase-4水平明显低于术前，差异有统计学意义(3.51±0.82)ng/ml vs. (4.33±0.96)ng/ml，P<0.05。死亡组NSCLC患者血清Caspase-4水平高于生存组，差异有统计学意义(5.01±0.63)ng/ml vs. (3.04±0.47)ng/ml，P<0.05。微波消融术后血清Caspase-4评估NSCLC患者预后的AUC、敏感度、特异性分别为0.851、65.79%、90.91%。Caspase-4≥3.17 ng/ml的NSCLC患者平均生存时间明显低于Caspase-4<3.17 ng/ml的NSCLC患者，差异有统计学意义30.19(95%CI：27.84～32.49)个月vs. 33.19(95%CI：31.77～34.60)个月，P<0.05。Cox单因素分析显示年龄、病理类型、分化程度、TNM分期、淋巴结转移、Caspase-4水平与NSCLC预后可能有关(P<0.05)，进一步Cox多因素回归分析显示TNM分期、淋巴结转移、Caspase-4水平与NSCLC患者预后密切相关(P<0.05)。 结论微波消融术后NSCLC患者血清Caspase-4水平明显降低，血清Caspase-4水平与NSCLC患者预后密切相关，检测术后血清Caspase-4水平对于评估NSCLC患者预后具有重要临床意义。

Changes and significance of serum Caspase-4 in patients with non-small cell lung cancer after microwave ablation

Objective To investigate the changes and significance of serum cysteinyl aspartate specific proteinase-4(Caspase-4)in patients with non-small cell lung cancer(NSCLC)after microwave ablation.Methods One hundred and fifty-nine patients with NSCLC admitted to our hospital and Provincial Cancer Hospital from March 2013 to January 2016 were selected as the subjects of study.All patients received microwave ablation.Serum Caspase-4 levels were measured by active fluorescence method in patients with NSCLC before and after radiofrequency ablation.Serum Caspase-4 levels in NSCLC patients with different prognosis were compared.The prognostic value of serum Caspase-4 in patients with NSCLC was analyzed by ROC curve.The mean survival time of NSCLC patients with different serum Caspase-4 levels was compared.Cox single factor and multi-factor analysis were used to analyze the related factors affecting the prognosis of patients with NSCLC.Results The serum Caspase-4 level of NSCLC patients after microwave ablation was significantly lower than that before operation,and the difference was statistically significant(3.51±0.82)ng/ml vs.(4.33±0.96)ng/ml,P<0.05].The serum Caspase-4 level of NSCLC patients in death group was significantly higher than that in survival group,and the difference was statistically significant(5.01±0.63)ng/ml vs.(3.04±0.47)ng/ml,P<0.05].The AUC,sensitivity and specificity of serum Caspase-4 in evaluating the prognosis of NSCLC patients after microwave ablation were 0.851,65.79%and 90.91%,respectively.The average survival time of NSCLC patients with Caspase-4≥3.17 ng/ml was significantly lower than that of NSCLC patients with Caspase-4<3.17 ng/ml,and the difference was statistically significant30.19(95%CI:27.84~32.49)months vs.33.19(95%CI:31.77~34.60)months,P<0.05].Cox univariate analysis showed that age,pathological type,degree of differentiation,TNM stage,lymph node metastasis,Caspase-4 levels might be related to the prognosis of NSCLC(P<0.05).Further Cox multivariate regression analysis showed that the TNM stages,lymph node metastasis and Caspase-4 were closely related to the prognosis of NSCLC patients(P<0.05).Conclusion The serum Caspase-4 level was significantly decreased in NSCLC patients after microwave ablation.The serum Caspase-4 level was closely related to the prognosis of NSCLC patients.Detecting the serum Caspase-4 level after microwave ablation has important clinical significance for evaluating the prognosis of NSCLC patients.