胃蛋白酶原1 对晚期胃癌临床预后的预测价值

Predictive value of pepsinogen-1 in clinical prognosis of advanced gastric cancer

摘要:

目的 探讨胃蛋白酶原1（PG1）对接受不同化疗联合靶向治疗方案的晚期胃癌（AGC）患者 临床预后的预测价值。方法 选取2011 年2 月—2013 年4 月于河南省南阳市中心医院就诊的AGC 患者109 例，根据治疗方案分为FLO 组和SOX 组，比较两组患者3、5 年生存率，以受试者工作特征（ROC）曲线 分析PG1 对临床预后的预测价值，并采用单因素和多因素回归分析影响AGC 生存率的危险因素。结果 A 组与B 组的3 和5 年生存率比较，差异无统计学意义（P >0.05）。PG1 预测FLO 组、SOX 组患者5 年生存 率的ROC 曲线下面积分别为0.869 和0.717，差异有统计学意义（P <0.05），FLO 组、SOX 组诊断折点分别 为54.43 和50.39 ng/ml ；FLO 组敏感性、特异性、阳性预测值、阴性预测值分别为79.3%、85.4%，80.9%、 86.1%，SOX 组分别为78.3%、82.9%，83.0%、80.1%，PG1 对FLO 组的预测价值高于SOX 组。单因素分析 结果表明，3 和5 年随访结束时死亡患者组织学低分化和PG1 ≤ 52.26 ng/ml 比例大于生存患者（P <0.05）。 多因素Logistic 回归分析结果表明，BMI>24 kg/m2 [Ol ^ R=1.103，（95% CI ：1.038，1.242），P =0.013]、组织 学低分化[Ol ^ R=1.107，（95% CI ：1.025，1.305），P =0.004]、脂肪肝[Ol ^ R=1.034，（95% CI ：1.006，1.323）， P =0.011]、PG1 ≤ 52.26 ng/ml [Ol ^ R=1.216，（95% CI：1.013，1.407），P =0.024] 是影响AGC 生存率的危险因素。 结论 PG1 对AGC 临床预后具有一定的预测价值，其中对FLO 治疗方案的预测意义更大。

Abstract:

Objective To investigate the predictive value of pepsinogen 1 (PG1) in clinical prognosis of advanced gastric cancer (AGC) receiving different chemotherapy combined with targeted therapy. Methods From February 2011 to April 2013, 109 patients with AGC were divided into group A (n = 53) and group B (n = 56) according to FLO and SOX. The 3-year and 5-year survival rates were compared between two groups. The predictive value of PG1 on clinical prognosis was analyzed by receiver operating characteristic (ROC) curve. Univariate and multivariate analysis were used to analyze the risk factors affecting AGC survival rate. Results The 3-year and 5-year survival rates of group A were 73.58% and 20.75% respectively, and those of group B were 75.00% and 21.43% respectively. There was no significant difference between the two groups (P > 0.05). The area under curve (AUC) of ROC in group A and group B predicted by PG1 was 0.869 and 0.717 respectively, and there was significant difference between the two groups (P < 0.05). The diagnostic breakpoints were 54.43ng/ml and 50.39ng/ml in FLO group and SOX group respectively. The sensitivity, specificity, positive predictive value and negative predictive value were 79.3%, 85.4%, 80.9% and 86.1% in FLO group, and 78.3%, 82.9%, 83.0% and 80.1% in SOX group respectively, indicating that the predictive value of PG1 in group A was higher than that in group B (P < 0.05). The proportion of histologically poor differentiation and PG1<52.26 ng/ml in patients with death were higher than those in survivors (P < 0.05). Multivariate logistic regression analysis showed that BMI>24 kg/ml (Ol ^ R=1.103, (95% CI: 1.038, 1.242)), histologically low differentiation (Ol ^ R=1.107, (95% CI: 1.025, 1.305)), fatty liver (Ol ^ R=1.034, (95% CI: 1.006, 1.323)) and PG1<52.26 ng/ml (Ol ^ R=1.216, (95% CI: 1.013, 1.407)) were independent risk factors for survival of AGC (P <0.05). Conclusions PG1 has a certain predictive value for clinical prognosis of AGC, and the prediction of FLO therapy is more significant.