首页|胃肿瘤标志物对胃癌新辅助治疗后病理完全缓解的预测价值

胃肿瘤标志物对胃癌新辅助治疗后病理完全缓解的预测价值

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目的:探究局部进展期胃癌(locally advanced gastric cancer,LAGC)新辅助治疗后病理完全缓解(pathological complete response,pCR)的影响因素,评估胃肿瘤标志物在LAGC患者pCR的预测价值.方法:回顾性分析 2020年 1月至 2024年 4月期间于中国人民解放军总医院第一医学中心接受新辅助治疗后行胃癌根治术及胃肿瘤标志物检查的 213例患者临床与病理资料,其中pCR组 20例,非pCR组 193例.比较pCR与胃肿瘤标志物、临床病理特征的相互关系,探究pCR的独立预测因素,并构建诺曼图预测模型.结果:213例患者中,20例(9.4%)患者术后病理结果提示pCR.单因素分析结果显示,年龄(P=0.067)、肿瘤瘤床直径(P<0.001)、胃泌素-17(P=0.005)、CA72-4(P=0.073)、胃蛋白酶原比值(PG1/PG2)(P=0.024)及新辅助免疫治疗(P=0.022)与LAGC患者新辅助治疗后pCR显著性相关(P<0.1).将上述指标纳入多因素分析,表明新辅助免疫治疗、CA72-4<2.5 U/mL、胃泌素-17<1.48 pmol/L、肿瘤瘤床直径<2.85 cm是LAGC患者pCR的独立影响因素(P<0.05).依托多因素指标构建诺曼图预测模型并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),AUC(95%CI)为0.863(0.785~0.942).校准曲线及临床决策曲线提示诺曼图校准良好且具有较好的净收益.结论:胃肿瘤标志物可有效预测LAGC患者新辅助治疗后pCR,以胃肿瘤标志物为基础构建的诺曼图具有良好的预测能力,可为临床决策提供参考.
The predictive value of gastric tumor markers for pathological complete response fol-lowing neoadjuvant therapy in gastric cancer
Objective:To investigate the risk factors of pathological complete response(pCR)after neoadjuvant therapy for locally advanced gastric cancer(LAGC)and assess the value of gastric tumor markers for predicting pCR in LAGC patients.Methods:We retrospectively ana-lyzed the clinical and pathological characteristics of 213 patients who underwent radical gastrectomy and gastric tumor marker analysis after neoadjuvant therapy at The Chinse PLA General Hospital First Medical Center,between January 2020 and April 2024(20 and 193 cases in the pCR and non-pCR groups,respectively).The interrelationships among pCR,tumor markers,and clinicopathological features were compared,and independent risk factors for pCR were analyzed.A nomogram was constructed to predict the pCR.Results:Among 213 patients,20(9.4% )achieved pCR.Univariate analysis showed that age(P=0.067),tumor bed diameter(P<0.001),gastrin-17 levels(P=0.005),CA72-4 levels(P=0.073),pepsinogen ratio(P=0.024),and neoadjuvant immunotherapy(P=0.022)were strongly associated with pCR in LAGC pa-tients.Multivariate analysis showed that neoadjuvant immunotherapy,CA72-4 levels<2.5 U/mL,gastrin-17 levels<1.48 pmol/L,and tumor bed diameter<2.85 cm were independent predictive factors for pCR in LAGC patients(P<0.05).These indicators were incorporated into a nomogram prediction model;an receiver operating characteristic curve(ROC)was plotted with an AUC(95% CI)of 0.863(0.785-0.942).The calibration and decision curves suggested that the nomogram was well calibrated and had a good net benefit.Conclusions:Gastric tumor markers can effectively predict pCR after neoadjuvant therapy in LAGC patients.Our nomogram showed a good predictive ability for pCR.Thus,our findings can serve as a useful reference for clinical decision making for LAGC patients.

gastric neoplasmtumor biomarkerneoadjuvant therapypathological complete response(pCR)nomogram

崔昊、梁文全、袁震、宋立强、杜家俊、卢誉元、崔建新、卫勃、陈凛

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南开大学医学院(天津市 300071)

北京大学国际医院胃肠外科

中国人民解放军总医院第一医学中心普通外科医学部

胃肿瘤 肿瘤标志物 新辅助治疗 病理完全缓解 诺曼图

国家自然科学基金国家自然科学基金北京市科技计划项目

8207319282273231Z221100007422125

2024

中国肿瘤临床
中国抗癌协会

中国肿瘤临床

CSTPCD北大核心
影响因子:1.32
ISSN:1000-8179
年,卷(期):2024.51(13)