Periostin蛋白在甲状腺乳头状癌临床诊断和预后中的应用价值研究

The application value of periostin protein in the clinical diagnosis and prognosis of papillary thyroid carcinoma

摘要:

目的 探讨Periostin蛋白在甲状腺乳头状癌（PTC）的临床诊断和预后中的应用价值研究。方法 回顾性分析2019年1月—2021年12月于邢台市人民医院行手术切除的180例PTC患者的病历资料。采用免疫组织化学染色检测癌组织（PTC组）和癌旁组织（癌旁组）中的Periostin蛋白的表达；分析PTC患者癌组织Periostin蛋白表达与临床病理特征的关系；采用受试者工作特征（ROC）曲线评估Periostin蛋白的诊断价值；随访3年，采用多因素一般Cox回归分析PTC患者预后的影响因素。结果 PTC组Periostin蛋白阳性率高于癌旁组（P <0.05）。ROC曲线分析结果显示，Periostin蛋白诊断PTC的曲线下面积为0.768（95% CI：0.712，0.827），敏感性为71.11%（95% CI：0.663，0.766）、特异性为84.44%（95% CI：0.802，0.887）。不同年龄、性别和肿瘤直径患者Periostin蛋白阳性率比较，差异均无统计学意义（P >0.05）；不同TNM分期、腺外有无侵犯、淋巴结是否转移、肿瘤数目、Periostin蛋白阳性率比较，差异均有统计学意义（P <0.05）；TNM Ⅲ、Ⅳ期、腺外有侵犯、有淋巴结转移、肿瘤数目多发、Periostin蛋白阳性率均升高。预后良好与预后不良患者的年龄、性别、肿瘤直径、肿瘤数目构成比比较，差异均无统计学意义（P >0.05）；预后良好与预后不良患者的TNM分期、腺外侵犯、淋巴结转移、Periostin蛋白阳性构成比比较，差异均有统计学意义（P <0.05）；预后良好组TNM Ⅰ、Ⅱ期占比、无腺外侵犯占比、无淋巴结转移占比、Periostin蛋白阳性占比均高于预后不良组。多因素一般Cox回归分析结果显示：TNM Ⅲ、Ⅳ期［H^R =2.798（95% CI：1.486，5.270）］、腺外侵犯［H^R =2.106（95% CI：1.082，4.102）］、淋巴结转移［H^R =2.540（95% CI：1.227，5.255）］、Periostin蛋白表达阳性［H^R =3.212（95% CI：1.841，5.605）］是PTC患者预后不良的危险因素（P <0.05）。结论 Periostin蛋白可作为PTC的诊断标志物，其高表达与肿瘤侵袭性及不良预后显著相关，为临床风险分层及治疗提供了重要依据。

Abstract:

Objective To explore the application value of Periostin protein in the clinical diagnosis and prognosis of papillary carcinoma of the thyroid (PTC).Methods A total of 180 PTC patients who underwent surgical resection from January 2019 to December 2021 were included. The expression of Periostin protein in cancer tissues (PTC group) and adjacent tissues (adjacent group) was detected by immunohistochemical staining. The correlation between Periostin and clinical pathological features was analyzed. The diagnostic value of Periostin protein was evaluated by ROC curve. The patients were followed up for three years, and the influencing factors of prognosis in PTC patients were explored by multivariate Cox regression analysis.Results There was a statistically significant difference in the positivity rate of Periostin protein between the PTC group and the adjacent cancer group (P < 0.05); The positive rate of Periostin protein in PTC group was higher than that in the adjacent cancer group. The ROC results showed that the AUC of Periostin protein for diagnosing PTC was 0.768 (95% CI: 0.712, 0.827), and its sensitivity and specificity were 71.11% (95% CI: 0.663, 0.766) and 84.44% (95% CI: 0.802, 0.887), respectively. There was no statistically significant difference in the positivity rate of Periostin protein among patients of different ages, genders, and tumor diameters (P > 0.05); There were statistically significant differences (P < 0.05) in the positivity rate of Periostin protein among patients with different TNM stages, presence of extraglandular invasion, lymph node metastasis, and tumor number; The positivity rate of Periostin protein increased in TNM stages III～IV, with extraglandular invasion, lymph node metastasis, and multiple tumor numbers. There was no statistically significant difference in age composition, gender composition, tumor diameter composition, and tumor number composition between the good prognosis group and the poor prognosis group (P > 0.05); The differences in TNM staging, extraglandular invasion, lymph node metastasis, and Periostin protein composition between the good prognosis group and the poor prognosis group were statistically significant (P < 0.05); The proportion of TNM stage Ⅰ~Ⅱ, no extraglandular invasion, no lymph node metastasis, and positive Periostin protein in the group with good prognosis are all higher than those in the group with poor prognosis. Multivariate Cox regression analysis showed that TNM stage Ⅲ~Ⅳ [H^R = 2.798 (95% CI: 1.486, 5.270) ], extraglandular invasion [H^R = 2.106 (95% CI: 1.082, 4.102) ], lymph node metastasis [H^R = 2.540 (95% CI: 1.227, 5.255) ], and positive expression of Periostin protein [H^R = 3.212 (95% CI: 1.841, 5.605) ] are risk factors for poor prognosis in PTC patients (P < 0.05).Conclusion Periostin protein can be used as a diagnostic marker for PTC, and its high expression is significantly associated with tumor invasiveness and poor prognosis, providing an important basis for clinical risk stratification and treatment.