胃充盈超声造影联合血清TGFBI、PD-L1对老年胃癌术前分期的诊断价值

doi:10.3877/cma.j.issn.2095-2015.2025.05.006

目的

探讨胃充盈超声造影联合血清转化生长因子β诱导物（TGFBI）、程序性死亡配体1（PD-L1）在老年胃癌术前分期中的诊断价值。

方法

回顾性选取2021年3月至2024年3月西安市第九医院收治的205例老年胃癌患者为研究对象，根据病理结果分为早期胃癌组69例和进展期胃癌组136例，所有患者均进行胃充盈超声造影检查。采用酶联免疫吸附法检测血清TGFBI、PD-L1水平；采用ROC曲线分析胃充盈超声造影、血清TGFBI、PD-L1水平单独及联合对老年胃癌术前分期的诊断价值；采用多因素Logistic回归分析分期错误的独立危险因素。

结果

进展期胃癌组血清TGFBI、PD-L1水平高于早期胃癌组（P<0.05）。胃充盈超声造影、TGFBI、PD-L1单独诊断老年胃癌术前分期的AUC为0.866、0.855、0.801，联合诊断的AUC为0.989，其中联合诊断的AUC高于三者单独诊断（Z=3.798、5.061、5.805，P<0.05）。根据胃充盈超声造影诊断结果分为分期正确组185例和分期错误组20例，分期错误组内镜下凹陷型比例、肿瘤直径>3 cm比例高于分期正确组（P<0.05）。内镜显示凹陷型、肿瘤直径>3 cm是分期错误的独立危险因素（P<0.05）。

结论

胃充盈超声造影联合血清TGFBI、PD-L1检测对老年胃癌术前分期的诊断价值较高。

关键词: 胃肿瘤, 术前分期, 胃充盈超声造影, 转化生长因子β诱导物, 程序性死亡配体1

Objective

To explore the diagnostic value of gastric filling contrast-enhanced ultrasound combined with serum transforming growth factor beta inducer (TGFBI) and programmed death molecule ligand 1 (PD-L1) in preoperative staging of elderly gastric cancer.

Methods

From March 2021 to March 2024, 205 elderly gastric cancer patients who visited our hospital were included as subjects. According to pathological results, they were assigned into an early gastric cancer group of 69 cases and an advanced gastric cancer group of 136 cases. All patients underwent gastric filling contrast-enhanced ultrasound examination. Enzyme linked immunosorbent assay was applied to detect the levels of TGFBI and PD-L1 in serum. The ROC curve was used to analyze the diagnostic value of gastric filling contrast-enhanced ultrasound, serum TGFBI, and PD-L1 levels alone and in combination for preoperative staging of elderly gastric cancer. Multivariate logistic regression analysis was used to screen independent risk factors for staging errors.

Results

The levels of serum TGFBI and PD-L1 in the advanced gastric cancer group were higher than those in the early gastric cancer group (P<0.05). The AUC of preoperative staging for elderly gastric cancer diagnosed by gastric filling contrast-enhanced ultrasound, TGFBI, and PD-L1 alone were 0.866, 0.855, and 0.801, respectively. The AUC of combined diagnosis was 0.989, with the AUC of combined diagnosis being higher than that of the three diagnoses alone (Z=3.798, 5.061, 5.805, P<0.05). According to the diagnosis results of gastric filling ultrasound contrast imaging, there were 185 cases in the correct staging group and 20 cases in the incorrect staging group. The proportions of concave morphology and tumor diameter greater than 3 cm in the incorrect staging group were higher than those in the correct staging group (P<0.05). Concave type and tumor diameter greater than 3 cm were independent risk factors for staging errors (P<0.05).

Conclusion

Gastric filling contrast-enhanced ultrasound combined with serum TGFBI and PD-L1 has high diagnostic value for preoperative staging of elderly gastric cancer.

Key words: Gastric neoplasms, Preoperative staging, Gastric filling contrast-enhanced ultrasound, Transforming growth factor beta inducer, Programmed death molecule ligand 1

表1 两组患者血清TGFBI、PD-L1水平比较（

±s）

组别	例数	TGFBI(ng/mL)	PD-L1(pg/mL)
早期胃癌组	69	11.64±3.53	257.14±67.61
进展期胃癌组	136	16.82±4.75	352.40±89.72
t		8.351	8.102
P		<0.001	<0.001

表1 两组患者血清TGFBI、PD-L1水平比较（

±s）

组别	例数	TGFBI(ng/mL)	PD-L1(pg/mL)
早期胃癌组	69	11.64±3.53	257.14±67.61
进展期胃癌组	136	16.82±4.75	352.40±89.72
t		8.351	8.102
P		<0.001	<0.001

图1 胃充盈超声造影、血清TGFBI、PD-L1单独及联合诊断老年胃癌术前分期的ROC曲线注：TGFBI转化生长因子β诱导物；PD-L1程序性死亡配体1

表2 胃充盈超声造影、血清TGFBI、PD-L1单独及联合对老年胃癌术前分期的诊断结果

诊断方法	敏感度	特异度	AUC	95% CI	P	约登指数	截断值
胃充盈超声造影	97.79	75.36	0.866	0.802~0.929	<0.001	0.73	0.84
TGFBI	77.21	81.16	0.855	0.803~0.906	<0.001	0.58	13.79 ng/mL
PD-L1	71.32	81.16	0.801	0.739~0.863	<0.001	0.52	292.75 pg/mL
联合	97.06	97.10	0.989	0.978~0.998	<0.001	0.94	0.96

表2 胃充盈超声造影、血清TGFBI、PD-L1单独及联合对老年胃癌术前分期的诊断结果

诊断方法	敏感度	特异度	AUC	95% CI	P	约登指数	截断值
胃充盈超声造影	97.79	75.36	0.866	0.802~0.929	<0.001	0.73	0.84
TGFBI	77.21	81.16	0.855	0.803~0.906	<0.001	0.58	13.79 ng/mL
PD-L1	71.32	81.16	0.801	0.739~0.863	<0.001	0.52	292.75 pg/mL
联合	97.06	97.10	0.989	0.978~0.998	<0.001	0.94	0.96

图2 胃充盈超声造影显示胃角占位，不规则，表面毛刺样

图3 胃充盈超声造影显示胃体后壁、胃窦部占位

图4 胃充盈超声造影显示胃角占位，边缘点样血流信号

表3 临床病理特征对胃充盈超声造影诊断准确性的影响

指标	分期正确组(n=185)	分期错误组(n=20)	t/χ²	P
年龄(岁,±s)	73.95±10.24	75.15±10.82	0.495	0.621
男性[例(%)]	114(61.62)	13(65.00)	0.087	0.768
病变部位[例(%)]			0.124	0.989
胃窦	108(58.38)	11(55.00)
胃体	34(18.38)	4(20.00)
胃底	27(14.59)	3(15.00)
贲门	16(8.65)	2(10.00)
内镜下形态[例(%)]			17.146	<0.001
平坦型	82(44.32)	3(15.00)
隆起型	66(35.68)	4(20.00)
凹陷型	37(20.00)	13(65.00)
肿瘤直径[例(%)]			11.832	0.001
≤3 cm	127(68.65)	6(30.00)
>3 cm	58(31.35)	14(70.00)
分化程度[例(%)]			0.391	0.532
中/高分化	115(62.16)	11(55.00)
低分化	70(37.84)	9(45.00)
浸润深度[例(%)]			0.231	0.630
≤1/2	121(65.41)	12(60.00)
>1/2	64(34.59)	8(40.00)

表3 临床病理特征对胃充盈超声造影诊断准确性的影响

指标	分期正确组(n=185)	分期错误组(n=20)	t/χ²	P
年龄(岁,±s)	73.95±10.24	75.15±10.82	0.495	0.621
男性[例(%)]	114(61.62)	13(65.00)	0.087	0.768
病变部位[例(%)]			0.124	0.989
胃窦	108(58.38)	11(55.00)
胃体	34(18.38)	4(20.00)
胃底	27(14.59)	3(15.00)
贲门	16(8.65)	2(10.00)
内镜下形态[例(%)]			17.146	<0.001
平坦型	82(44.32)	3(15.00)
隆起型	66(35.68)	4(20.00)
凹陷型	37(20.00)	13(65.00)
肿瘤直径[例(%)]			11.832	0.001
≤3 cm	127(68.65)	6(30.00)
>3 cm	58(31.35)	14(70.00)
分化程度[例(%)]			0.391	0.532
中/高分化	115(62.16)	11(55.00)
低分化	70(37.84)	9(45.00)
浸润深度[例(%)]			0.231	0.630
≤1/2	121(65.41)	12(60.00)
>1/2	64(34.59)	8(40.00)

表4 分期错误影响因素的logistic回归分析

影响因素	B	SE	Wald χ²	OR	95% CI	P
内镜下形态	1.071	0.345	9.635	2.918	1.484~5.738	0.002
肿瘤直径	1.056	0.325	10.566	2.876	1.521~5.438	0.001

表4 分期错误影响因素的logistic回归分析

影响因素	B	SE	Wald χ²	OR	95% CI	P
内镜下形态	1.071	0.345	9.635	2.918	1.484~5.738	0.002
肿瘤直径	1.056	0.325	10.566	2.876	1.521~5.438	0.001

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Diagnostic value of gastric filling contrast-enhanced ultrasound combined with serum TGFBI and PD-L1 for preoperative staging of elderly gastric cancer

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Diagnostic value of gastric filling contrast-enhanced ultrasound combined with serum TGFBI and PD-L1 for preoperative staging of elderly gastric cancer