摘要
目的 探讨术前血清Krüpple样因子5(KLF5)、双皮质素样激酶1(DCLK1)水平对前列腺癌患者腹腔镜根治性切除术后预后不良的预测价值。方法 选取2018年5月至2021年5月青海大学附属医院收治的119例拟行腹腔镜根治性切除术治疗的前列腺癌患者作为研究对象,术前检测其血清KLF5、DCLK1水平。所有患者术后均接受规律随访,根据随访过程中复发情况评估预后并设为预后不良组、预后良好组,比较两组术前血清KLF5、DCLK1水平,分析术前血清KLF5、DCLK1水平对术后预后不良的预测价值。结果 119例前列腺癌患者随访过程中有2例失访,1例因意外死亡;116例患者中有34例预后不良,发生率29.31%。预后不良组术前血清KLF5、DCLK1水平均高于预后良好组(P<0.05)。预后不良组切缘阳性患者占比、术前前列腺特异性抗原(PSA)水平、Gleason评分高于预后良好组(P<0.05)。COX回归分析显示,术前PSA水平、Gleason评分、切缘阳性及术前血清KLF5、DCLK1水平均为预后不良的影响因素(P<0.05)。限制性立方样条模型(RCS)分析显示,术前血清KLF5、DCLK1水平与前列腺癌患者根治性切除术后预后不良的关联强度呈线性剂量反应关系(P<0.05),当患者术前血清KLF5、DCLK1水平分别>12.91 ng/m L、4.73 ng/m L时,预后不良风险随指标升高而增加。KaplanMeier生存曲线分析显示,不同术前血清KLF5、DCLK1水平患者的生存曲线比较,差异具有统计学意义(Log-rank=18.573、6.579,P<0.001、0.01)。绘制受试者工作特征(ROC)曲线显示,术前血清KLF5、DCLK1水平联合预测前列腺癌根治性切除术后预后不良的曲线下面积(AUC)高于各项单独预测(P<0.05)。结论 前列腺癌患者腹腔镜根治性切除术后预后不良与术前血清KLF5、DCLK1有关,当患者术前血清KLF5、DCLK1水平分别>12.91 ng/m L、4.73 ng/m L时,预后不良风险随指标升高而增加,且二者联合检测可作为临床预测预后不良的敏感指标。
Objective To investigate the predictive value of preoperative serum levels of Krüpple like factor 5(KLF5)and doublecortin like kinase 1(DCLK1)for poor prognosis in patients with prostate cancer undergoing laparoscopic radical resection.Methods A total of 119 prostate cancer patients who underwent laparoscopic radical resection at Affiliated Hospital of Qinghai University from May 2018 to May 2021 were selected as the study subjects.Serum KLF5 and DCLK1 levels were measured before surgery.All patients received regular follow-up after surgery,the prognosis was evaluated based on the recurrence situation during the follow-up process,and they were divided into poor prognosis group and good prognosis group.The preoperative serum KLF5 and DCLK1 levels were compared between the two groups,and the predictive value of preoperative serum KLF5 and DCLK1 levels for poor postoperative prognosis was analyzed.Results During the follow-up process of 119 prostate cancer patients,2 cases were lost to follow-up and 1 case died unexpectedly.Out of 116 patients,34 cases had poor prognosis,with an incidence rate of 29.31%.The preoperative serum levels of KLF5 and DCLK1 in poor prognosis group were higher than good prognosis group(P<0.05).The proportion of patients with positive margins,preoperative prostate-specific antigen(PSA)levels,and Gleason score in the poor prognosis group were higher than those in the good prognosis group(P<0.05).COX regression analysis showed that preoperative PSA levels,Gleason scores,positive margins,and preoperative serum KLF5 and DCLK1 levels were all factors affecting poor prognosis(P<0.05).The restricted cubic spline model(RCS)analysis showed that there was a linear dose-response relationship between preoperative serum KLF5 and DCLK1 levels and poor prognosis after radical prostatectomy in prostate cancer patients(P<0.05).When the preoperative serum KLF5 and DCLK1 levels were>12.91 ng/mL and 4.73 ng/mL,respectively,the risk of poor prognosis increased with the increase of indicators.Kaplan-Meier survival curve analysis showed that there was a statistically significant difference in survival curves between patients with different preoperative serum KLF5 and DCLK1 levels(Log-rank=18.573,6.579;P<0.001,0.01).The receiver operating characteristic curve was plotted to show that the combined prediction of preoperative serum KLF5 and DCLK1 levels for poor prognosis after radical prostatectomy had a higher area under the curve(AUC)than individual predictions(P<0.05).Conclusions The poor prognosis of prostate cancer patients after laparoscopic radical resection is related to preoperative serum KLF5 and DCLK1 levels.When the preoperative serum KLF5 and DCLK1 levels of patients are>12.91 ng/mL and 4.73 ng/mL,respectively,the risk of poor prognosis increases with the increase of indicators,and the combined detection of the two can be used as a sensitive indicator for predicting poor prognosis in clinical practice.
作者
张宝琳
任海林
孔祥峰
张院东
强紫阳
ZHANG Baolin;REN Hailin;KONG Xiangfeng;ZHANG Yuandong;QIANG Ziyang(Department of Urology,Affiliated Hospital of Qinghai University,Xining 810000,Qinghai,China)
出处
《中国性科学》
2025年第10期53-59,共7页
Chinese Journal of Human Sexuality
基金
青海省科技计划项目(2021-ZJ-723)
青海大学附属医院中青年科研基金一般项目(ASRF-2022-YB-05)。
