血清TGF-β1、VEGF水平对非小细胞肺癌患者单孔胸腔镜根治术后复发的预测价值

摘要/Abstract

摘要：

目的分析血清转化生长因子β1（TGF-β1）、血管内皮生长因子（VEGF）对非小细胞肺癌（NSCLC）患者单孔胸腔镜根治术后复发的预测价值。方法选取徐州医科大学附属医院2018年5月至2020年5月就诊的50例行单孔胸腔镜根治术治疗的NSCLC患者为研究对象，比较手术前后血清TGF-β1、VEGF水平、Karnofsky功能状态（KPS）评分，统计并发症总发生率。对所有研究对象进行为期3年的随访，比较复发组与未复发组、存活组与死亡组患者的血清TGF-β1、VEGF水平及KPS评分，采用Pearson相关分析探讨TGF-β1、VEGF与KPS评分的相关性。绘制受试者操作特征（ROC）曲线，计算曲线下面积（AUC），评估血清TGF-β1、VEGF单独及联合检测对NSCLC患者单孔胸腔镜根治术后复发的预测价值。结果50例NSCLC患者单孔胸腔镜根治术后1个月血清TGF-β1水平为（7.16±1.94）μg/L、VEGF水平为（42.26±5.04）ng/L，均低于术前的（13.62±3.52）μg/L、（136.52±20.66）ng/L（t=11.37，P<0.001；t=31.34，P<0.001）；术后1个月KPS评分为（66.57±8.11）分，高于术前的（53.62±5.62）分（t=9.28，P<0.001）。50例患者术后1例发生切口延迟愈合、1例肺部感染，无肺栓塞等其他并发症发生，并发症总发生率为4.00%。复发组（n=6）患者的血清TGF-β1水平为（12.95±4.26）μg/L、VEGF水平为（72.46±6.05）ng/L，均高于未复发组（n=44）的（6.37±1.25）μg/L、（38.14±5.37）ng/L（t=8.34，P<0.001；t=29.99，P<0.001）；复发组患者的KPS评分为（52.16±8.16）分，低于未复发组的（67.55±12.67）分（t=2.88，P=0.006）。死亡组（n=5）患者的血清TGF-β1水平为（13.99±6.82）μg/L、VEGF水平为（75.95±9.05）ng/L，均高于存活组（n=45）的（6.41±3.06）μg/L、（38.52±8.37）ng/L（t=4.56，P<0.001；t=21.47，P<0.001）；死亡组患者的KPS评分为（1.25±0.34）分，低于存活组的（65.11±12.94）分（t=10.93，P<0.001）。Pearson相关分析显示，血清TGF-β1（r=-0.45，P<0.001）、VEGF（r=-0.48，P<0.001）水平均与KPS评分呈负相关。ROC曲线分析显示，TGF-β1最佳截断取值8.14 µg/L时，对单孔胸腔镜根治术后复发预测的AUC为0.516（95%CI为0.446~0.676），敏感性为71.85%，特异性为80.69%；VEGF最佳截断取值142 ng/L时，AUC为0.659（95%CI为0.534~0.761），敏感性为76.04%，特异性为82.52%；两者联合检测的AUC为0.828（95%CI为0.786~0.951），敏感性为91.86%，特异性为87.52%；两者联合检测的AUC优于TGF-β1、VEGF单独检测（Z=2.63，P=0.007；Z=2.32，P=0.013）。结论NSCLC患者行单孔胸腔镜根治术治疗1个月后，血清TGF-β1、VEGF水平明显降低，两者联合检测对单孔胸腔镜根治术后复发具有较高的预测价值。

关键词:转化生长因子β1,血管内皮生长因子,癌,非小细胞肺,治疗结果,单孔胸腔镜根治术

Abstract:

ObjectiveTo analyze the predictive value of serum transforming growth factor-β1 （TGF-β1） and vascular endothelial growth factor （VEGF） in patients with non-small cell lung cancer （NSCLC） after single-port thoracoscopic radical resection.MethodsA total of 50 patients with NSCLC who underwent single-port thoracoscopic radical resection in Affiliated Hospital of Xuzhou Medical University from May 2018 to May 2020 were selected as the observation objects. Serum TGF-β1， VEGF levels and Karnofsky functional status （KPS） scores before and after surgery were compared， and the total incidence of complications was calculated. All subjects were followed up for 3 years， and serum levels of TGF-β1， VEGF and KPS scores were compared between relapsed group and non-relapsed group， survival group and death group. Pearson correlation analysis was used to explore the correlation between TGF-β1， VEGF and KPS scores. The receiver operator characteristic （ROC） curve was plotted and the area under the curve （AUC） was calculated to evaluate the predictive value of serum TGF-β1 and VEGF alone and combined detection in patients with NSCLC after single-port thoracoscopic radical resection.ResultsThe serum levels of TGF-β1 and VEGF were （7.16±1.94） μg/L and （42.26±5.04） ng/L in 50 patients with NSCLC one month after single-port thoracoscopic radical resection， which were lower than those before surgery [（13.62±3.52） μg/L and （136.52±20.66） ng/L，t=11.37，P<0.001；t=31.34，P<0.001]. The KPS score one month after surgery was 66.57±8.11， which was higher than that before surgery （53.62±5.62，t=9.28，P<0.001）. Postoperative wound healing was delayed in 1 of the 50 patients， pulmonary infection in 1 patient， and no pulmonary embolism and other complications occurred. The total incidence of complications was 4.00%. The serum levels of TGF-β1 and VEGF in patients in the relapsed group （n=6） were （12.95±4.26） μg/L and （72.46±6.05） ng/L respectively， which were higher than those in the non-relapsed group （n=44） [（6.37±1.25） μg/L and （38.14±5.37） ng/L；t=8.34，P<0.001；t=29.99，P<0.001]. The KPS score in the relapsed group was 52.16±8.16， which was lower than that in the non-relapsed group （67.55±12.67，t=2.88，P=0.006）. Serum levels of TGF-β1 and VEGF in the death group （n=5） were （13.99±6.82） μg/L and （75.95±9.05） ng/L， which were higher than those in the survival group （n=45） [（6.41±3.06） μg/L and （38.52±8.37） ng/L；t=4.56，P<0.001；t=21.47，P<0.001]. The KPS score in the death group was 1.25±0.34， which was lower than that in the survival group （65.11±12.94，t=10.93，P<0.001）. Pearson correlation analysis showed that serum levels of TGF-β1 （r=-0.45，P<0.001） and VEGF （r=-0.48，P<0.001） were negatively correlated with KPS scores. ROC curve analysis showed that when the optimal cut-off value of TGF-β1 was 8.14 µg/L， the AUC for predicting recurrence after single-port thoracoscopic radical resection was 0.516 （95%CI：0.446-0.676）， the sensitivity was 71.85%， and the specificity was 80.69%. When the optimal cut-off value of VEGF was 142 ng/L， the AUC was 0.659 （95%CI：0.534-0.761）， the sensitivity was 76.04%， and the specificity was 82.52%. The AUC of the combined detection was 0.828 （95%CI：0.786-0.951）， the sensitivity was 91.86%， and the specificity was 87.52%. The AUC of combined detection was higher than that of serum TGF-β1 （Z=2.63，P=0.007）， VEGF（Z=2.32，P=0.013） single detection.ConclusionThe serum levels of TGF-β1 and VEGF are significantly decreased in NSCLC patients after one month of single-port thoracoscopic radical resection， and the combined detection of the two has predictive value for recurrence after single-port thoracoscopic radical resection.

Key words:Transforming growth factor beta1,Vascular endothelial growth factors,Carcinoma,non-small-cell lung,Treatment outcome,Single-port thoracoscopic radical surgery

王昆, 周中新, 臧其威. 血清TGF-β1、VEGF水平对非小细胞肺癌患者单孔胸腔镜根治术后复发的预测价值[J]. 国际肿瘤学杂志, 2024, 51(4): 198-203.

Wang Kun, Zhou Zhongxin, Zang Qiwei. Predictive value of serum TGF-β1 and VEGF levels in patients with non-small cell lung cancer after single-port thoracoscopic radical resection[J]. Journal of International Oncology, 2024, 51(4): 198-203.

图/表4

时间	TGF-β1（µg/L）	VEGF（ng/L）	KPS评分（分）
术前	13.62±3.52	136.52±20.66	53.62±5.62
术后1个月	7.16±1.94	42.26±5.04	66.57±8.11
t值	11.37	31.34	9.28
P值	<0.001	<0.001	<0.001

表1

组别	TGF-β1（µg/L）	VEGF（ng/L）	KPS评分（分）
复发组（n=6）	12.95±4.26	72.46±6.05	52.16±8.16
未复发组（n=44）	6.37±1.25	38.14±5.37	67.55±12.67
t值	8.34	29.99	2.88
P值	<0.001	<0.001	0.006

表2

组别	TGF-β1（µg/L）	VEGF（ng/L）	KPS评分（分）
死亡组（n=5）	13.99±6.82	75.95±9.05	1.25±0.34
存活组（n=45）	6.41±3.06	38.52±8.37	65.11±12.94
t值	4.56	21.47	10.93
P值	<0.001	<0.001	<0.001

表3

图1

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