术前血清乳酸脱氢酶和碱性磷酸酶水平对评估胰腺癌预后的临床价值
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摘要
目的分析术前血清乳酸脱氢酶(LDH)和碱性磷酸酶(ALP)水平与胰腺癌预后的关系,为探寻具有临床价值的胰腺癌预后预测因子提供科学依据。方法选取2014年1月至2016年6月在该院确诊为胰腺癌并住院接受手术治疗的132例患者作为研究对象,收集所有患者临床病历一般资料、术前血清LDH和ALP及其他实验室指标,通过单因素和多因素分析血清LDH和ALP与胰腺癌预后的关系。结果胰头癌易引起血清LDH、ALP水平升高(P<0.05)。高水平LDH的胰腺癌患者更易发生局部浸润(P<0.05),但在高水平ALP的胰腺癌患者中不明显(P>0.05)。中晚期胰腺癌患者LDH水平易升高(P<0.05),但胰腺癌TNM分期与ALP无明显相关性(P>0.05)。血清LDH和ALP水平与胰腺癌大小、周围神经侵犯与否及分化情况无相关性(P>0.05),但高水平LDH(HR=1.667,95%CI=1.235～2.213,P=0.004)及高水平ALP(HR=2.011,95%CI=1.332～4.543,P<0.001)是胰腺癌远期预后不良的独立危险因素。结论血清LDH和ALP水平可在一定程度上反映胰腺癌增殖与进展能力,且与胰腺癌远期预后密切相关,有望成为协助预测胰腺癌预后的生物学指标。
Objective To analyze the relationship between preoperative serum lactate dehydrogenase(LDH)and alkaline phosphatase(ALP)and prognosis of pancreatic cancer,and to provide scientific basis for exploring prognostic factors of pancreatic cancer.Methods A total of 132 patients diagnosed with pancreatic cancer and operated in the hospital from January 2014 to June 2016 were selected as research objects.The clinical data,preoperative serum LDH and ALP,and other laboratory indicators of all patients were collected.The relationship between serum LDH and ALP and the prognosis of pancreatic cancer was analyzed by univariate and multivariate analysis.Results Serum LDH and ALP were increased in pancreatic head cancer(P<0.05),and local infiltration and lymph node metastasis occurred more likely in pancreatic cancer patients with high level LDH(P<0.05),but not common in pancreatic cancer patients with high level of ALP(P>0.05).LDH level was prone to elevate in patients with advanced pancreatic cancer(P<0.05),but there was no significant correlation between TNM stage and ALP(P>0.05).Serum LDH and ALP levels were not related to pancreatic cancer size,peripheral nerve invasion and differentiation(P>0.05).However,high levels of LDH and ALP were independent risk factors for long-term poor prognosis of pancreatic cancer,including LDH(HR=1.667,95%CI=1.235-2.213,P=0.004),ALP(HR=2.011,P<0.001),respectively.Conclusion Serum LDH and ALP levels could reflect the proliferation and progression of pancreatic cancer,and are closely related to the long-term prognosis of pancreatic cancer.The serum LDH and ALP levels were expected to become a biological index to predict the prognosis of pancreatic cancer.
Objective To analyze the relationship between preoperative serum lactate dehydrogenase(LDH)and alkaline phosphatase(ALP)and prognosis of pancreatic cancer,and to provide scientific basis for exploring prognostic factors of pancreatic cancer.Methods A total of 132 patients diagnosed with pancreatic cancer and operated in the hospital from January 2014 to June 2016 were selected as research objects.The clinical data,preoperative serum LDH and ALP,and other laboratory indicators of all patients were collected.The relationship between serum LDH and ALP and the prognosis of pancreatic cancer was analyzed by univariate and multivariate analysis.Results Serum LDH and ALP were increased in pancreatic head cancer(P<0.05),and local infiltration and lymph node metastasis occurred more likely in pancreatic cancer patients with high level LDH(P<0.05),but not common in pancreatic cancer patients with high level of ALP(P>0.05).LDH level was prone to elevate in patients with advanced pancreatic cancer(P<0.05),but there was no significant correlation between TNM stage and ALP(P>0.05).Serum LDH and ALP levels were not related to pancreatic cancer size,peripheral nerve invasion and differentiation(P>0.05).However,high levels of LDH and ALP were independent risk factors for long-term poor prognosis of pancreatic cancer,including LDH(HR=1.667,95%CI=1.235-2.213,P=0.004),ALP(HR=2.011,P<0.001),respectively.Conclusion Serum LDH and ALP levels could reflect the proliferation and progression of pancreatic cancer,and are closely related to the long-term prognosis of pancreatic cancer.The serum LDH and ALP levels were expected to become a biological index to predict the prognosis of pancreatic cancer.
引文
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[16]VETTRAINO M,MANERBA M,GOVONI M,et al.Galloflavin suppresses lactate dehydrogenase activity and causes MYC downregulation in burkitt lymphoma cells through NAD/NADH-dependent inhibition of sirtuin-1[J].Anticancer Drugs,2013,24(8):862-870.
[17]RAO S R,SNAITH A E,MARINO D,et al.Tumour-derived alkaline phosphatase regulates tumour growth,epithelial plasticity and disease-free survival in metastatic prostate cancer[J].Br J Cancer,2017,116(2):227-236.
[2]LEIBOVITCH I,VEINREB M,STERENBERG I,et al.Prosthetic valvular hemolysis:apotential pitfall in the routine use of serum lactate dehydrogenase as tumor marker in patients with germ cell testicular tumors[J].Isr Med Assoc J,2006,8(9):659-660.
[3]LIU L,HE Y,GE G,et al.Lactate dehydrogenase and creatine kinase as poor prognostic factors in lung cancer:a retrospective observational study[J].PLoS One,2017,12(8):e0182168.
[4]PU N,GAO S,XU Y,et al.Alkaline phosphatase-to-albumin ratio as a prognostic indicator in pancreatic ductal adenocarcinoma after curative resection[J].J Cancer,2017,8(16):3362-3370.
[5]HUNG H Y,CHEN J S,TANG R,et al.Preoperative alkaline phosphatase elevation was associated with poor survival in colorectal cancer patients[J].Int J Colorectal Dis,2017,32(12):1775-1778.
[6]DONG Y,LI Y,JIN B,et al.Pathologic subtype-defined prognosis is dependent on both tumor stage and status of oncogenic driver mutations in lung adenocarcinoma[J].Oncotarget,2017,8(47):82244-82255.
[7]WEN S,ZHAN B,FENG J,et al.Non-invasively predicting differentiation of pancreatic cancer through comparative serum metabonomic profiling[J].BMC Cancer,2017,17(1):708-709.
[8]YANG Z,YE P,XU Q,et al.Elevation of serum GGT and LDH levels,together with higher BCLC staging are associated with poor overall survival from hepatocellular carcinoma:a retrospective analysis[J].Discov Med,2015,19(17):409-418.
[9]WEI X L,ZHANG D S,HE M M,et al.The predictive value of alkaline phosphatase and lactate dehydrogenase for overall survival in patients with esophageal squamous cell carcinoma[J].Tumour Biol,2016,37(2):1879-1887.
[10]ZHANG M,WEI S,SU L,et al.Prognostic significance of pretreated serum lactate dehydrogenase level in nasopharyngeal carcinoma among Chinese population:a meta-analysis[J].Medicine(Baltimore),2016,95(35):e4494.
[11]EIKAWA S,UDONO H.Metabolic competition in tumor microenvironment[J].Gan To Kagaku Ryoho,2017,44(11):972-976.
[12]SHAFAEE A,DASTYAR D Z,ISLAMIAN J P.Inhibition of tumor energy pathways for targeted esophagus cancer therapy[J].Metabolism,2015,64(10):1193-1198.
[13]HANSE E A,RUAN C,KACHMAN M,et al.Cytosolic malate dehydrogenase activity helps support glycolysis in actively proliferating cells and cancer[J].Oncogene,2017,36(27):3915-3924.
[14]KUMAR D.Regulation of glycolysis in head and neck squamous cell carcinoma[J].Postdoc J,2017,5(1):14-28.
[15]PATHAK C,JAISWAL Y K,VINAYAK M.Modulation in the activity of lactate dehydrogenase and level of c-myc and cfos by modified base queuine in cancer[J].Cancer Biol Ther,2008,7(1):85-91.
[16]VETTRAINO M,MANERBA M,GOVONI M,et al.Galloflavin suppresses lactate dehydrogenase activity and causes MYC downregulation in burkitt lymphoma cells through NAD/NADH-dependent inhibition of sirtuin-1[J].Anticancer Drugs,2013,24(8):862-870.
[17]RAO S R,SNAITH A E,MARINO D,et al.Tumour-derived alkaline phosphatase regulates tumour growth,epithelial plasticity and disease-free survival in metastatic prostate cancer[J].Br J Cancer,2017,116(2):227-236.