血清TrxR1水平与中晚期结直肠癌根治术后复发转移的关系研究  

Study on the relationship between serum thioredoxin reductase 1 level and recurrence and metastasis of middle-and advanced-stage colorectal cancer after radical resection

作　　者：利春梅 徐超 陈慧敏 李其肯[1] 周鹏扬 陈伟平[1] LI Chunmei;XU Chao;CHEN Huimin;LI Qiken;ZHOU Pengyang;CHEN Weiping(Department of Colorectal Surgery,Zhejiang Cancer Hospital,Hangzhou 310022,China)

机构地区：[1]浙江省肿瘤医院结直肠外科,杭州310022 [2]浙江省肿瘤医院中西医结合科,杭州310022

出　　处：《浙江医学》2025年第2期151-156,共6页Zhejiang Medical Journal

基　　金：浙江省中医药科技计划项目(2021ZB030);浙江省医药卫生科技计划项目(2021KY575);浙江省重点研发计划项目(2023C04018)。

摘　　要：目的探讨血清硫氧还蛋白还原酶(TrxR)1水平与中晚期结直肠癌(CRC)根治术后复发转移的关系。方法回顾性选取2020年1月至2023年8月浙江省肿瘤医院收治的311例中晚期CRC患者为研究对象,检测患者接受CRC根治术后以及经4~6周期标准方案化疗后血清TrxR1水平。比较术后TrxR1高、低表达组临床资料,绘制Kaplan-Meier曲线分析不同病理分期患者术后TrxR1表达与复发转移的关系,采用Cox回归模型分析Ⅱ、Ⅲ期患者CRC术后复发转移的影响因素。结果术后TrxR1水平≤8 U/mL有224例,为低表达组;>8 U/mL有87例,为高表达组。两组患者N分期、M分期、术后化疗方案、复发转移、复发转移化疗及疗效比较,差异均有统计学意义(均P<0.05)。在Ⅱ、Ⅲ期患者中,术后TrxR1高表达者术后3年复发转移率均明显高于低表达者(均P<0.05);在Ⅳ期患者中,术后TrxR1高、低表达者术后3年复发转移率比较差异无统计学意义(P=0.817)。术后化疗方案以奥沙利铂为主(HR=0.079,P=0.008)是Ⅱ期患者术后复发转移的独立保护因素,术后TrxR1高表达(HR=5.791,P=0.027)是Ⅱ期患者术后复发转移的独立危险因素。术后化疗方案以奥沙利铂为主(HR=0.190,P=0.005)是Ⅲ期患者术后复发转移的独立保护因素,N2期(HR=2.418,P=0.004)、术后TrxR1高表达(HR=1.978,P=0.046)均是Ⅲ期患者术后复发转移的独立危险因素。结论CRC术后血清TrxR1高表达的Ⅱ、Ⅲ期患者更易出现复发转移。Objective To investigate the relationship between serum thioredoxin reductase 1(TrxR1)level and recurrence and metastasis of middle-and advanced-stage colorectal cancer(CRC)after radical surgery.Methods A total of 311 cases of middle-and advanced-stage CRC admitted to Zhejiang Cancer Hospital from January 2020 to August 2023 were analyzed for the study.Their serum TrxR1 levels were detected after CRC radical surgery and 4-6 cycles of standard chemotherapy.Clinical data of postoperative TrxR1 high-and low-expression groups were compared,and Kaplan-Meier curves were drawn to analyze the relationship between postoperative TrxR1 expression and recurrence and metastasis of patients at different clinical stages.Cox regression model was used to analyze the influencing factors for postoperative recurrence and metastasis of CRC patients at stagesⅡandⅢ.Results There were 224 cases with TrxR1 level≤8 U/mL after operation,which was the low expression group.Eighty-seven cases with TrxR1 level>8 U/mL were regarded as the high expression group.Statistically significant differences were observed between the two groups in N stage,M stage,postoperative chemotherapy regimen,recurrence and metastasis,chemotherapy for recurrence and metastasis and its efficacy(all P<0.05).For patients at stagesⅡandⅢ,the recurrence and metastasis rates of patients with high expression of TrxR1 were significantly higher than those with TrxR1 low expression at 3 years after surgery(both P<0.05).For patients at stageⅣ,there was no significant difference between low-and high-expression groups in the recurrence and metastasis rates at 3 years after surgery(P=0.817).Oxaliplatin was mainly used in postoperative chemotherapy regimen(HR=0.079,P=0.008),which was an independent protective factor for postoperative recurrence and metastasis of stageⅡpatients,while postoperative high expression of TrxR1(HR=5.791,P=0.027)was an independent risk factor.Oxaliplatin-based postoperative chemotherapy regimen was also an independent protective factor for pos

关 键 词：结直肠癌 硫氧还蛋白还原酶 复发转移 疗效 预后 

分 类 号：R73[医药卫生—肿瘤]