Clinical significance of serum ANGPTL4 in the diagnosis of preoperative lymph node metastasis of T1 stage colorectal cancer
Objective To evaluate the clinical value of serum ANGPTL 4 combined with tumor markers in predicting preoperative lymph node metastasis(LNM)of colorectal cancer(CRC).Methods One hundred and seventy-eight patients with submucosal infiltration(T1)CRC admitted to 980th Hospital of PLA Joint Logistic Support Force from March 2020 to November 2022 were studied.Imaging and postoperative histopathology confirmed 80 cases in the LNM group and 98 cases in the non-LNM group.Serum ANGPTL4 levels were measured by enzyme-linked immunosorbent assay(ELISA),and the relationship between the expression of ANGPTL4 and the clinicopathological features of CRC was analyzed.Multivariate Logistic regression model was used to analyze the influencing factors of LNM.The efficacy of serum ANGPTL4 combined with tumor markers in the diagnosis of LNM was analyzed by receiver operating characteristic curve(ROC).Results The levels of serum ANGPTL4[1.68(1.17,3.16)AU vs.0.73(0.23,1.40)AU]and CEA[1.50(0.80,2.29)ng/ml vs.0.91(0.48,1.85)ng/ml]in LNM group were higher than those in non-LNM group.The difference was statistically significant(P<0.05).According to the median value of serum ANGPTL4 level,they were divided into high level group(≥0.93AU)and low level group(<0.93AU).The proportion of female patients with high serum ANGPTL4 level was slightly higher,and the incidence of LNM was higher(P<0.05).Multivariate Logistic regression model analysis showed that MSI,CEA and ANGPTL4 levels were independent factors affecting the occurrence of LNM in patients with stage T1 CRC(P<0.05).ROC curve result showed that serum ANGPTL4 and CEA could diagnose LNM(P<0.05).When serum ANGPTL4≥0.93AU and CEA≥4.35 ng/ml,the combined predicted area under the curve(AUC)was 0.878(95%CI:0.829-0.927),respectively.Conclusion Preoperative serum ANGPTL4 has the potential to be a biomarker for predicting LNM in patients with T1 stage CRC,and it has higher diagnostic efficacy combined with tumor markers.
Angiopoietin-like protein 4Colorectal cancerLymph node metastasisSubmucosal infiltrationTumor markers
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