The Value of Serum Adipokine in the Long-term Prognosis of Colorectal Cancer Patients
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摘要:
目的 探讨血清脂肪因子在结直肠癌远期预后中的评估价值。 方法 80例结直肠癌患者作为研究对象，另选取同期健康体检者80例作为对照组。比较2组以及结直肠癌不同肿瘤病理特征间患者血清脂肪因子水平，计算5 a总生存率并绘制生存曲线，进行相关性分析、多因素分析以及比较脂肪因子对5 a生存情况的预测效能。 结果 与对照组相比，结直肠癌患者的内脂素与瘦素水平均显著升高（P < 0.05），脂联素水平显著降低（P < 0.05）；肿瘤不同病理特征间比较，不同肿瘤分化程度及TNM分期间内脂素、脂联素以及瘦素水平比较差异有统计学意义（P < 0.05）；生存曲线结果表明：内脂素、脂联素以及瘦素不同质量浓度间患者的五年生存时间分布差异显著（χ2 = 4.715，4.530，7.011，P = 0.030，0.033，0.008）；相关性分析结果表明：脂联素与肿瘤分化程度、TNM分期及5 a总生存率均呈显著的负相关性（P < 0.05），瘦素与肿瘤分化程度、TNM分期及5总生存率均呈显著的正相关（P < 0.05），内脂素与肿瘤分化程度及TNM分期均无显著相关性（P > 0.05），与5 a总生存率呈显著正相关性（P < 0.05）；多因素分析结果表明，内脂素与瘦素是结直肠癌患者五年生存情况的危险因素，而脂联素是其保护因素；ROC曲线结果表明，3项指标联合预测的AUC、敏感度及特异度均高于其单独预测。 结论 内脂素及瘦素是结直肠癌患者5 a生存的危险因素，脂联素是保护因素，其指标联合具有更高的5 a生存预测效能。 Abstract:Objective To evaluate the value of serum adipokine in the long-term prognosis of colorectal cancer. Methods 80 patients with colorectal cancer were selected as the study subjects, and 80 healthy subjects were selected as the control group. Serum adipokine levels were compared between the two groups and the patients with different pathological characteristics of colorectal cancer tumors. The 5-year overall survival rate was calculated and the survival curve was drawn. Correlation analysis, multivariate analysis and the prediction efficiency of adipokine on 5-year survival were compared. Results Compared with the control group, the levels of visfatin and leptin in colorectal cancer patients were significantly increased （P < 0.05）, and the levels of adiponectin were significantly decreased （P < 0.05）. There were statistically significant differences in the levels of visfatin, adiponectin and leptin in different stages of tumor differentiation and TNM （P < 0.05）. The results of survival curve showed that the 5-year survival time distribution of patients with different concentrations of visfatin, adiponectin and leptin was significantly different （χ2 = 4.715, 4.530, 7.011, P = 0.030, 0.033, 0.008）. Correlation analysis results show that adiponectin was significantly negatively correlated with tumor differentiation, TNM stage and 5-year overall survival rate （P < 0.05）, leptin was significantly positively correlated with tumor differentiation, TNM stage and 5-year overall survival rate （P < 0.05）, while visfatin was not significantly correlated with tumor differentiation and TNM stage （P > 0.05）. There was significant positive correlation with 5-year overall survival rate （P < 0.05）. Multivariate analysis showed that visfatin and leptin were the risk factors for five-year survival of colorectal cancer patients, while adiponectin was the protective factor. The results of ROC curve showed that the AUC, sensitivity and specificity of the combined prediction of the three indexes were higher than those of the independent prediction. Conclusion Visfatin and leptin are risk factors for 5a survival in colorectal cancer patients, while adiponectin is a protective factor. The combination of these indicators has higher efficacy in predicting 5-year survival. -
Key words:
- Adipokine /
- Colorectal cancer /
- Long-term prognosis /
- Assessed value
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图 1 内脂素、脂联素以及瘦素低质量浓度与高质量浓度患者的总生存期对比（月）
A：表示内脂素低质量浓度与高质量浓度患者总生存期比较；B：表示脂联素低质量浓度和高质量浓度患者的总生存期比较；C：表示瘦素低质量浓度和高质量浓度患者的总生存期比较。* P < 0.05。
Figure 1. Comparison of overall survival between patients with low and high concentrations of visfatin，adiponectin and leptin （months）
*P < 0.05。
图 2 内脂素、脂联素及瘦素联合检测对结肠癌患者5 a生存情况预测ROC曲线
Figure 2. ROC curve for predicting 5-year survival of colon cancer patients with visfatin，adiponectin and leptin combined detection
*P < 0.05。
表 1 组间内脂素、脂联素及瘦素水平比较（
$ \bar x \pm s $ ）Table 1. Comparison of visfatin，adiponectin and leptin levels between groups （
$ \bar x \pm s $ ）组别 n 内脂素
（ng/mL）脂联素
（μg/mL）瘦素
（ng/mL）对照组 80 6.58 ± 2.89 19.82 ± 4.80 2.35 ± 1.13 结直肠癌组 80 17.25 ± 4.22 12.71 ± 5.69 4.42 ± 1.45 t 18.659 8.543 10.072 P < 0.01 < 0.01 < 0.01 
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表 2 肿瘤不同病理特征间血清脂肪因子水平比较（
$ \bar x \pm s $ ）Table 2. Comparison of serum adipokine levels among different pathological features of tumors （
$ \bar x \pm s $ ）项目 n 内脂素（ng/mL） t/P 脂联素（μg/mL） t/P 瘦素（ng/mL） t/P 年龄 <60岁 21 16.76 ± 4.19 0.912/
0.36413.37 ± 6.51 0.554/
0.5813.59 ± 1.26 0.676/
0.500≥60岁 59 17.68 ± 3.89 12.58 ± 5.26 3.83 ± 1.44 性别 男性 52 17.41 ± 4.25 0.319/
0.75110.42 ± 5.22 2.221/
0.0293.62 ± 1.49 0.940/
0.350女性 28 17.12 ± 3.06 12.98 ± 4.29 3.96 ± 1.57 肿瘤位置 直肠 34 17.83 ± 6.55 0.533/
0.59611.51 ± 5.39 1.297/
0.1983.81 ± 1.13 1.039/
0.302结肠 46 17.11 ± 5.52 13.22 ± 6.13 3.45 ± 1.77 肿瘤分化程度 高分化 13 14.86 ± 2.37 3.155/
0.04613.85 ± 4.56 5.143/
0.0082.96 ± 1.32 7.052/
0.002*中分化 48 16.69 ± 3.08 13.46 ± 4.63 3.66 ± 1.73 低分化 19 17.98 ± 3.49 10.76 ± 3.87 3.94 ± 1.81 TNM分期 Ⅱ 26 15.47 ± 2.92 3.718/
0.02114.72 ± 3.73 3.127/
0.0493.32 ± 1.47 3.498/
0.035*Ⅲ 43 17.08 ± 3.57 12.66 ± 3.61 3.67 ± 1.56 Ⅳ 11 18.44 ± 3.38 11.19 ± 2.73 4.25 ± 1.49 *P < 0.05。
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表 3 脂肪因子与肿瘤分化程度、TNM分期及5 a总生存率的相关性分析
Table 3. Correlation analysis between adipokines and tumor differentiation，TNM stage and five-year overall survival rate
项目 肿瘤分化程度 TNM分期 5 a总生存率 r P r P r P 内脂素 0.082 0.471 0.005 0.965 0.688 0.000* 脂联素 −0.341 0.002 −0.274 0.014 −0.727 0.000* 瘦素 0.386 0.000* 0.269 0.016* 0.238 0.034* *P < 0.05。
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表 4 多因素分析
Table 4. Multivariate analysis
影响因素 B SE wald OR（95%CI） P 内脂素 0.603 0.132 20.926 1.824（1.409～2.361） 0.000* 脂联素 −1.047 0.246 18.114 0.352（0.218～0.569） 0.000* 瘦素 0.377 0.183 4.236 1.459（1.018～2.089） 0.040* *P < 0.05。
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表 5 内脂素、脂联素及瘦素联合检测对结肠癌患者5 a生存情况预测效能分析
Table 5. Analysis of the efficacy of visfatin，adiponectin and leptin combined detection in predicting 5-year survival of colon cancer patients
检验项目 AUC 标准误 渐近显著性水平 95% CI 最佳临界值 敏感度（%） 特异度（%） 约登指数 下限值 上限值 内脂素 0.921 0.041 < 0.001 0.837 1.000 16.558 91.3 91.2 0.825 脂联素 0.626 0.071 0.079 0.487 0.765 4.638 39.1 84.2 0.233 瘦素 0.936 0.027 < 0.001 0.883 0.989 12.748 87.0 84.2 0.712 联合预测 0.994 0.007 < 0.001 0.000 1.000 0.411 100.00 98.2 0.982
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