血浆外泌体VPS37C联合肿瘤标志物糖类抗原125、碱性磷酸酶在转移性结直肠癌诊断中的临床价值

背景 结直肠癌（CRC）转移的早期诊断对患者预后非常关键，外泌体蛋白与结直肠癌的转移密切相关。因此，我们评估了血浆外泌体蛋白VPS37C联合肿瘤标志物CA125及碱性磷酸酶ALP在区分转移及非转移CRC患者中的临床意义。方法 研究共纳入102例样本，包括46例非转移性结直肠癌（nmCRC）患者，39例转移性结直肠患者（mCRC）和17例健康志愿者。通过透射电子显微镜、纳米粒子追踪分析和蛋白质印迹鉴定血清中分离的外泌体。通过ELISA和受试者曲线（ROC）单独或联合CA125、ALP分析检测VPS37C的表达和诊断效能。结果 循环血浆外泌体VPS37C、血清CA125、ALP在结直肠癌转移患者中均显著升高（P＜0.05）；在TNM分期方面，三者均表现为在IV期患者中显著升高（P＜0.05）；在对于mCRC的诊断效能方面，三个指标两两联用或三个指标共同联用时的诊断效能显著高于任一指标单独使用的效果，VPS37C与CA125和ALP联合时达到最大诊断效能，敏感性（90.91%），特异性（78.69%），ROC曲线下面积最大（AUC=0.8139；P<0.05）。结论 循环血浆外泌体VPS37C与血清CA125、ALP均能较好的区分mCRC与nmCRC，且在TNM分期方面具有一定的区分能力。外泌体VPS37C可能是有价值的mCRC诊断标志物，并且联合血清CA125及ALP对于mCRC具有更佳的临床诊断价值。

Study on the Value of Plasma Exosomal VPS37C Combined with Tumor Markers CA125 and Alkaline Phosphatase in the Diagnosis of Metastatic Colorectal Cancer

Background Exosomal proteins are closely associated with metastasis in colorectal cancer, and early diagnosis of colorectal cancer metastasis is critical for patient prognosis. We evaluated the clinical significance of plasma exosomal VPS37C in combination with CA125 and ALP in distinguishing patients with metastatic and non-metastatic CRC. Methods A total of 102 samples, including 46 patients with non-metastatic colorectal cancer (nmCRC), 39 patients with metastatic colorectal disease (mCRC) and 17 healthy volunteers, were included in the study. Exosomes isolated from participants'' sera were confirmed by transmission electron microscopy, nanoparticle tracking analysis and protein blotting. Expression and diagnostic efficacy of VPS37C was measured by ELISA and subject curve (ROC) analysis alone or in combination with CA125 and ALP. Results Circulating exosome VPS37C levels were significantly elevated in patients with metastatic colorectal cancer (P <0.05), and its maximum diagnostic efficacy was achieved in combination with CA125 and ALP, with the largest area under the ROC curve (AUC=0.8139; P <0.05). Conclusion Circulating exosome VPS37C is significantly upregulated with serum CA125 and ALP in mCRC patients and can be used as a potential diagnostic biomarker for mCRC.