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ENGLISH ABSTRACT
早期胃癌患者血清TGFBI、COL10A1水平与其ESD术后复发的关系研究
薛玲
王志伟
作者及单位信息
·
DOI： 10.3760/cma.j.cn341190-20240523-00618
Association of serum levels of TGFBI and COL10A1 with recurrence after endoscopic submucosal dissection in patients with early gastric cancer
Xue Ling
Wang Zhiwei
Authors Info & Affiliations
Xue Ling
Department of Oncology, Hanzhong Central Hospital, Hanzhong 723000, Shaanxi Province, China
Wang Zhiwei
Department of Digestive Surgery, Hanzhong Central Hospital, Hanzhong 723000, Shaanxi Province, China
·
DOI： 10.3760/cma.j.cn341190-20240523-00618
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摘要

目的探讨早期胃癌患者血清转化生长因子-β诱导蛋白（TGFBI）、Xɑ1型胶原蛋白（COL10A1）水平及其与内镜黏膜下剥离术（ESD）术后复发的关系。

方法采取前瞻性研究，选择2020年3月至2023年3月汉中市中心医院收治的行ESD治疗的早期胃癌患者110例为研究对象，采用横断面研究方法，患者ESD术后随访1年，记录患者期间复发情况，并分为复发组、未复发组。患者入院时均接受血清TGFBI、COL10A1检测，统计患者基线资料。分析早期胃癌患者血清TGFBI、COL10A1水平与ESD术后复发的剂量反应关系。

结果随访术后1年，110例早期胃癌患者ESD术后复发17例，复发率为15.45%，复发组肿瘤最长径［（2.37±0.41）cm］长于未复发组［（1.85±0.34）cm］；复发组患者血清TGFBI、COL10A1水平［（27.85±6.27）μg/L、（7.03±1.05）μg/L］均高于未复发组［（19.28±4.15）μg/L、（6.14±0.77）μg/L］，临床分期为Ⅱa～Ⅱb、浸润深度为黏膜下层患者［52.94%（9/17）、70.59%（12/17）］占比高于未复发组［24.73%（23/93）、43.01%（40/93）］（ t=5.61、7.17、4.12， χ 2=4.26、4.38，均 P < 0.05）；二元logistics回归分析结果显示，早期胃癌患者肿瘤最长径长、血清TGFBI、COL10A1高表达是ESD术后复发的危险因素（ OR=65.341、1.401、2.855，均 P < 0.05）；受试者工作特征（ROC）曲线分析显示，早期胃癌患者血清TGFBI、COL10A1及联合预测ESD术后复发的曲线下面积（AUC）分别为0.869、0.800、0.954；早期胃癌患者血清TGFBI、COL10A1与ESD术后复发的关联强度均呈线性剂量反应关系（均 P < 0.05），特别当血清TGFBI > 22.29 μg/L、COL10A1 > 6.95 μg/L时，早期胃癌患者ESD术后复发风险随血清TGFBI、COL10A1水平升高而升高。

结论早期胃癌患者血清TGFBI、COL10A1水平与ESD术后复发密切相关，两者水平越高患者复发风险越高。

胃肿瘤;胃黏膜;内窥镜检查，胃肠道;转化生长因子β;复发;回归分析;ROC曲线
ABSTRACT

ObjectiveTo investigate the association between serum levels of transforming growth factor beta-induced protein (TGFBI) and type X alpha1 collagen (COL10A1) in patients with early gastric cancer and the recurrence of cancer after endoscopic submucosal dissection (ESD).

MethodsA prospective study was conducted involving 110 patients with early gastric cancer who underwent ESD at the Hanzhong Central Hospital from March 2020 to March 2023. This study used a cross-sectional study design, with patients followed up for 1 year post-ESD to assess recurrence. Patients were categorized into the recurrence group and the non-recurrence group. Upon admission, all patients underwent serum testing for TGFBI and COL10A1, and baseline data were collected. The dose-response relationship between serum levels of TGFBI and COL10A1 and the recurrence of cancer after ESD was analyzed.

ResultsAfter 1 year of follow-up, recurrence was observed in 17 out of 110 patients with early gastric cancer who underwent ESD, resulting in a recurrence rate of 15.45%. In the recurrent group, the longest diameter of the tumors [(2.37 ± 0.41) cm] was significantly longer than that in the non-recurrent group [(1.85 ± 0.34) cm]. Additionally, serum levels of TGFBI and COL10A1 in the recurrence group were (27.85 ± 6.27) μg/L and (7.03 ± 1.05) μg/L, respectively, which were significantly higher than those in the non-recurrence group [(19.28 ± 4.15) μg/L, (6.14 ± 0.77) μg/L]. The proportion of patients with clinical stages Ⅱa-b and submucosal infiltration depth was significantly greater in the recurrence group [52.94% (9/17), 70.59% (12/17)] than in the non-recurrence group [24.73% (23/93), 43.01% (40/93) in the non-recurrent group. All observed differences were statistically significant ( t = 5.61, 7.17, 4.12, χ 2 = 4.26, 4.38, all P < 0.05). The results of the binary logistic regression analysis showed that the longest tumor diameter, high serum levels of TGFBI and COL10A1 expression were risk factors for recurrence after ESD in patients with early gastric cancer ( OR = 65.341, 1.401, 2.855, all P < 0.05). The results of the receiver operating characteristic curve analysis indicated that the areas under the curve for the predictive value of serum TGFBI and COL10A1, both individually and in combination, for recurrence after ESD were 0.869, 0.800, and 0.954, respectively. A linear dose-response relationship was identified between serum levels of TGFBI and COL10A1 and the risk of cancer recurrence after ESD in patients with early gastric cancer (all P < 0.05). Specifically, when serum TGFBI levels exceeded 22.29 μg/L and COL10A1 levels surpassed 6.95 μg/L, the risk of cancer recurrence increased with higher serum levels of both TGFBI and COL10A1.

ConclusionsIn patients with early gastric cancer, serum levels of TGFBI and COL10A1 are closely related to cancer recurrence after ESD. The higher the serum levels of TGFBI and COL10A1, the greater the risk of recurrence.

Stomach neoplasms;Gastric mucosa;Endoscopy, gastrointestinal;Transforming growth factor beta;Recurrence;Regression analysis;ROC curve
Wang Zhiwei, Email: mocdef.3ab6100654321iewihzgnaw
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引用本文

薛玲,王志伟. 早期胃癌患者血清TGFBI、COL10A1水平与其ESD术后复发的关系研究[J]. 中国基层医药,2025,32(03)：347-352.

DOI:10.3760/cma.j.cn341190-20240523-00618

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早期胃癌可局部切除治疗，尽早诊治，对提升患者生存率，延长生存时间有重要意义 ［ 1 ］ 。内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）是临床治疗早期胃癌的重要方式，具有损伤小、术后恢复快的优势。但有研究指出，早期胃癌经ESD治疗后，仍有部分患者发生局部复发，威胁患者生命安全 ［ 2 ］ 。因此临床急需探寻可影响早期胃癌患者ESD术后复发的相关因素。转化生长因子-β诱导蛋白（recombinant transforming hrowth factor beta induced protein，TGFBI）具有介导细胞黏附与迁移的作用。临床研究显示，TGFBI在肿瘤血管形成中发挥重要作用，可影响肿瘤供氧及免疫细胞浸润 ［ 3 ］ 。Xɑ1型胶原蛋白（X alpha 1 chain，COL10A1）是主要的间质基质成分。相关研究显示，COL10A1在多种恶性肿瘤中呈高表达，如食管癌、结肠癌等 ［ 4 , 5 ］ 。但COL10A1在胃癌复发过程中所发挥的作用机制尚未明确。鉴于此，本研究着重分析早期胃癌患者血清TGFBI、COL10A1水平对ESD术后复发的影响。
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备注信息
A
王志伟，Email： mocdef.3ab6100654321iewihzgnaw
B

薛玲：采集数据、起草文章；王志伟：统计分析、技术支持

C
薛玲, 王志伟. 早期胃癌患者血清TGFBI、COL10A1水平与其ESD术后复发的关系研究[J]. 中国基层医药,2025,32(3):347-352. DOI:10.3760/cma.j.cn341190-20240523-00618.
D
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