术前血清GDF-8、TTF-1水平与腹腔镜结直肠癌根治术后复发转移的关系

Association of preoperative serum GDF-8 and TTF-1 levels with recurrence and metastasis after laparoscopic radical resection for colorectal cancer

摘要:

目的 探讨术前血清生长分化因子-8（GDF-8）、甲状腺转录因子-1（TTF-1）水平与腹腔镜结直肠癌根治术后复发转移的关系。方法 选取2022年10月—2024年10月于邢台医学院第二附属医院接受腹腔镜根治术的128例结直肠癌患者。根据术后12个月内复发转移情况将患者分为复发转移组（34例）和无复发转移组（94例）。比较两组血清GDF-8、TTF-1水平。绘制受试者工作特征（ROC）曲线评估预测价值；进行单因素分析，并通过多因素逐步Logistic回归模型分析腹腔镜结直肠癌根治术后复发转移的影响因素。结果 复发转移组术前、术后GDF-8、TTF-1水平均高于无复发转移组；两组术后GDF-8水平均升高（P <0.05），术后TTF-1水平均降低（P <0.05）。ROC曲线结果显示，术前GDF-8联合TTF-1预测腹腔镜结直肠癌根治术后复发转移的曲线下面积为0.904（95% CI：0.873，0.942），高于单独预测。联合预测的敏感性为85.3%（95% CI：0.832，0.873），特异性为86.2%（95% CI：0.842，0.881）。复发转移组年龄≥60岁占比、TNM分期Ⅲ期占比、低分化占比、脉管侵犯率、神经侵犯率和肿瘤直径≥5 cm占比均高于无复发转移组（P <0.05）。多因素逐步Logistic回归分析结果显示，TNM分期Ⅲ期［O^R=3.435（95% CI：1.562，7.553）］、分化程度低［O^R=3.016（95% CI：1.592，5.714）］、肿瘤直径≥5 cm［O^R=2.678（95% CI：1.436，4.994）］、术前GDF-8≥16.83 μg/L［O^R=2.782（95% CI：1.509，5.127）］、术前TTF-1≥15.47 μg/L［O^R=2.759（95% CI：1.428，5.331）］均为腹腔镜结直肠癌根治术后复发转移的危险因素（P <0.05）。结论 术前血清GDF-8、TTF-1升高与腹腔镜结直肠癌根治术后复发转移密切相关，且两者联合检测的预测效能较好。

Abstract:

Objective To investigate the association of preoperative serum levels of growth differentiation factor-8 (GDF-8) and thyroid transcription factor-1 (TTF-1) with postoperative recurrence and metastasis in patients undergoing laparoscopic radical resection for colorectal cancer.Methods A total of 128 patients with colorectal cancer who underwent laparoscopic radical resection at our hospital between October 2022 and October 2024 were enrolled. Patients were categorized into recurrence/metastasis (n = 34) and non-recurrence/metastasis (n = 94) groups based on postoperative events within 12 months. Serum GDF-8 and TTF-1 levels were compared between groups. Predictive value was assessed via receiver operating characteristic (ROC) curve analysis. Univariable analysis was performed, followed by multivariable stepwise logistic regression analysis to identify factors influencing postoperative recurrence and metastasis in patients undergoing laparoscopic colorectal cancer resection.Results Preoperative and postoperative GDF-8 and TTF-1 levels were significantly higher in the recurrence/metastasis group than in the non-recurrence/metastasis group (P < 0.05). Postoperative GDF-8 levels increased in both groups (P < 0.05), while postoperative TTF-1 levels decreased in both groups (P < 0.05). ROC curve analysis revealed that the AUC of preoperative GDF-8 combined with preoperative TTF-1 in predicting postoperative recurrence and metastasis in colorectal cancer patients undergoing laparoscopic radical resection was 0.904 (95% CI: 0.873, 0.942), higher than that of either individual marker. The combined prediction demonstrated a sensitivity of 85.3% (95% CI: 0.832, 0.873) and a specificity of 86.2% (95% CI: 0.842, 0.881). The proportions of patients aged ≥ 60 years and those with TNM stage III disease, poorly differentiated tumors, lymphovascular invasion, perineural invasion, and tumor diameter ≥ 5 cm were all higher in the recurrence/metastasis group than in the non-recurrence/metastasis group (P < 0.05). Multivariable stepwise logistic regression analysis revealed that TNM stage III disease [O^R = 3.435 (95% CI: 1.562, 7.553) ], poorly-differentiated tumors [O^R = 3.016 (95% CI: 1.592, 5.714) ], tumor diameter ≥ 5 cm [O^R = 2.678 (95% CI: 1.436, 4.994) ], preoperative GDF-8 ≥ 16.83 μg/L [O^R = 2.782 (95% CI: 1.509, 5.127) ], and preoperative TTF-1 ≥ 15.47 μg/L [O^R = 2.759 (95% CI: 1.428, 5.331) ] were all risk factors for postoperative recurrence and metastasis in colorectal cancer patients undergoing laparoscopic radical resection (P < 0.05).Conclusion Elevated preoperative serum GDF-8 and TTF-1 levels are closely associated with postoperative recurrence and metastasis in colorectal cancer patients undergoing laparoscopic radical resection, and combined detection of both markers demonstrates good predictive efficacy.