系统性炎症负荷联合趋化因子MIP-3α在低位直肠癌淋巴结转移预测中的作用

Predictive value of systemic inflammatory burden combined with chemokine MIP-3α for lymph node metastasis in low rectal cancer

摘要:

背景与目的 低位直肠癌因解剖位置特殊，易发生淋巴结转移，是影响术后复发与远处转移的重要因素。传统影像学预测手段仍存在一定局限。炎症微环境及趋化因子在肿瘤转移中的作用日益受到关注。本研究旨在探讨术前炎症负荷指数（IBI）和巨噬细胞炎性蛋白3α（MIP-3α）对低位直肠癌患者淋巴结转移的预测价值。方法 回顾性分析2020年1月—2024年1月在青岛市中医医院接受直肠癌根治性手术的182例低位直肠癌患者资料。术前检测血清MIP-3α水平和C-反应蛋白、中性粒细胞、淋巴细胞水平，计算IBI，术后依据淋巴结病理结果分为淋巴结转移阳性组和阴性组。采用单因素及多因素Logistic回归分析淋巴结转移的独立危险因素，并绘制受试者工作特征曲线（ROC）与Hosmer-Lemeshow校准曲线评价预测效能。结果 182例患者中70例（38.46%）发生淋巴结转移。淋巴结转移阳性组和阴性组在肿瘤分化程度、分期、血管侵犯、淋巴管侵犯、术前中性粒细胞/淋巴细胞比值、IBI及MIP-3α水平方面差异均有统计学意义（P<0.05）。多因素分析显示，壁外血管侵犯（OR=4.870）、淋巴管侵犯（OR=5.387）、IBI（OR=2.143）及MIP-3α（OR=1.539）为淋巴结转移的独立危险因素（均P<0.05）。ROC分析显示，IBI和MIP-3α的曲线下面积（AUC）分别为0.782和0.767，联合模型AUC为0.821，预测效能明显优于单一指标（P<0.05），Hosmer-Lemeshow检验提示模型校准良好（P=0.721）。结论 术前IBI与MIP-3α水平均可有效预测低位直肠癌患者淋巴结转移风险，二者联合应用可进一步提高预测效能，有助于术前风险分层与个体化治疗决策。

Abstract:

Background and Aims Low rectal cancer is prone to lymph node metastasis due to its special anatomical location, which is a key determinant of postoperative recurrence and distant metastasis. The predictive accuracy of conventional imaging methods remains limited. Increasing evidence suggests that the inflammatory microenvironment and chemokines play important roles in tumor metastasis. This study aimed to investigate the predictive value of preoperative inflammatory burden index (IBI) and macrophage inflammatory protein 3α (MIP-3α) for lymph node metastasis in patients with low rectal cancer.Methods A total of 182 patients with low rectal cancer who underwent radical resection between January 2020 and January 2024 were retrospectively analyzed. Preoperative serum MIP-3α levels, C-reactive protein, neutrophils and lymphocytes were detected, and the IBI was calculated. Patients were divided into the lymph node metastasis-positive and -negative groups according to postoperative pathological findings. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for LNM. Receiver operating characteristic (ROC) curves and Hosmer-Lemeshow calibration curves were used to evaluate predictive performance.Results LNM occurred in 70 patients (38.46%). Significant differences were observed between the lymph node metastasis-positive and -negative groups regarding tumor differentiation, tumor stage, vascular invasion, lymphatic invasion, preoperative neutrophil to lymphocyte ratio, IBI, and MIP-3α levels (all P<0.05). Multivariate analysis identified extramural vascular invasion (OR=4.870), lymphatic invasion (OR=5.387), IBI (OR=2.143), and MIP-3α (OR=1.539) as independent predictors of LNM (all P<0.05). The AUC values of IBI and MIP-3α were 0.782 and 0.767, respectively, while the combined model achieved an AUC of 0.821, which was significantly superior to either marker alone (P<0.05). The Hosmer-Lemeshow test demonstrated good calibration (P=0.721).Conclusion Preoperative IBI and MIP-3α are effective predictors of lymph node metastasis in low rectal cancer. Their combined application further improves predictive accuracy and may facilitate preoperative risk stratification and individualized treatment.