The Clinical Value Of Tumor Abnormal Protein In Colorectal Cancer Liver Metastasis

BackgroundColorectal cancer is one of the world’s most prevalent cancers.Approximately two-thirds of colorectal cancer patients will develop distant recurrence and metastasis at some point in time.Distant metastases are most commonly found in the liver.Patients with colorectal cancer liver metastases had an extremely poor overall survival rate 30 years ago.But in recent years,with the development of surgery,neoadjuvant chemotherapy,and biologic agents,the prognosis and survival of patients with liver metastases from colorectal cancer have improved dramatically.However,with the development of surgery,neoadjuvant chemotherapy,and biological agents,the prognosis and survival of colorectal cancer patients with liver metastases have improved tremendously in recent years.Therefore,early diagnosis of liver metastases and timely treatment can improve the prognosis of patients.At present,most clinics rely on pathological biopsy and imaging examinations such as ultrasound,CT,and MRI to confirm the diagnosis of liver metastases,but the unsatisfactory sampling of biopsy sites,the lag of imaging examinations,and the expensive cost make many patients miss the best treatment period.Therefore,it is crucial to find the latest types of serological markers and take targeted combined tests to confirm liver metastasis at an early stage.In this study,the expression levels of tumor abnormal protein（TAP）,carcinoembryonic antigen（CEA）,and carbohydrate antigen 199（CA199）in the peripheral blood of CRLM patients were investigated.The aim is to investigate the role of TAP alone and in combination in the early screening and complementary diagnosis of CRLM.ObjectiveThe clinicopathological data of patients were analyzed to study the value of the size of TAP cohesive area in the staging,grading,metastasis and prognosis of colorectal cancer liver metastasis.To investigate the adjunctive diagnostic value of single and combined tests for early screening of patients with colorectal cancer liver metastases by detecting the expression levels of TAP,CEA,CA199,NLR and Cys-C in patients with colorectal cancer liver metastases.MethodsThe metastatic group consisted of 89 patients admitted to Xinxiang Central Hospital between May 2018 and May 2020 who had liver metastases of colorectal cancer verified by CT or pathological testing.Ninety-three colorectal cancer patients without liver metastasis at the time of consultation during the same period were used as the non-metastatic group.The clinicopathological data of patients was analyzed to study the relationship between the size of the TAP coalescence area and the stage,grading,metastasis,and prognosis of colorectal cancer.TAP,CEA,CA199,NLR,and Cys-C levels were compared between the two groups,and the clinical value of single and combined indexes for colorectal cancer liver metastasis was assessed.Results1.General information of patients in both groupsIn terms of age,gender,and primary tumor location,there was no statistically significant difference between the two groups（P>0.05）.2.Correlation of TAP expression levels with clinical profile characteristics in CRLM patientsThe level of TAP expression correlated with the T-stage of the primary foci and the degree of differentiation of the primary foci（P<0.05）,and there was no significant correlation between age,gender,primary tumor site,and N-stage of the primary foci（P>0.05）.3.Tumor and serum marker detection in two groups of patientsPatients in the metastatic group had higher TAP,CEA,CA199,NLR,and serum Cys-C than those in the non-metastatic group,and the difference was statistically significant（P<0.05）.4.Logistic regression analysis of risk factors for liver metastasis of colorectal cancerMulti-factor binary logistic regression analysis yielded that and TAP,CEA,CA199,NLR and serum Cys-C indicators were independent risk factors for liver metastasis of colorectal cancer（P<0.05）.5.Evaluation of the effectiveness of a single index to predict liver metastasis from colorectal cancerThe clinical sensitivity of TAP,CEA,CA199,NLR,and serum Cys-C single assays were 80.90%,69.70%,65.20%,74.20%,and 64.00%,respectively;the clinical specificity was 77.40%,79.60%,90.30%,72.00%,and 88.20%,respectively;and the ROC curves for TAP,CEA,CA199,NLR,and serum Cys-C were 210.34μm~2,6.31 ng/ml,37.66 U/ml,2.45,and 1.12 mg/ml,respectively.The critical values of TAP,CEA,CA199,NLR and serum Cys-C for predicting CRLM were 210.34μm~2,6.31 ng/ml,37.66 U/ml,2.45 and1.12 mg/L,respectively.The three indicators below the critical values were considered as no liver metastasis,and above the critical values were considered as liver metastasis,and the above indicators were evaluated in terms of authenticity and reliability.The AUCs of TAP,CEA,CA199,NLR,and serum Cys-C for predicting CRLM were 0.842,0.811,0.805,0.785,and 0.789,respectively,and were analyzed using Med Calc software,and there was no statistical difference in the AUCs between the five indicators of TAP,CEA,CA199,NLR,and serum Cys-C for two comparisons（P>0.05）.6.Evaluation of the effect of joint prediction of CRLM by multiple indicatorsThe clinical sensitivity of TAP combined with CEA,TAP combined with CA199,TAP combined with NLR,TAP combined with Cys-C,and CEA combined with CA199 assays were 92.10%,83.10%,82.20%,79.80%,and 72.40%,respectively;the clinical specificity was 75.30%,88.20%,81.70%,88.20%,and 84.90%;one of the two indicators was positive,that is,the AUCs of TAP combined with CEA,TAP combined with CA199,TAP combined with NLR,TAP combined with Cys-C,and CEA combined with CA199 in two series were0.902,0.919,0.881,0.888,and 0.833,respectively.The AUCs of TAP,CEA,and CA199 in two series were 0.902,0.919,0.881,0.888,and 0.833,respectively.The clinical sensitivity of the combined assay of TAP,CEA,and CA199 was 84.30%and the specificity was90.30%;one of the three indicators of TAP,CEA,and CA199 was positive,that is,positive,and the AUC of the three indicators in tandem to predict CRLM was 0.934,which was analyzed by Med Calc software.The AUC differences between the combined test and the single,TAP combined with CEA,TAP combined with CA199,TAP combined with NLR,TAP combined with Cys-C,and CEA combined with CA199 tests,respectively,were statistically significant（P<0.05）.Conclusions1.The size of TAP cohesive area is related to the progression and metastasis of colorectal cancer liver metastasis.2.The combined test of TAP,CEA and CA199 helps to improve the diagnosis rate of CRLM.