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Abstract
Background/Aims
Endoscopic submucosal dissection (ESD) is commonly used for radical resection of gastric adenoma and mucosal cancer, but there is about 30% of discrepancy rate between the histology of the endoscopic biopsy and that of the resected specimen obtained from the same lesion by ESD. The aim of this study was to clarify the clinical significance of IL-6, VEGF, CRP before ESD.
Methods
We investigated the correlation between serum IL-6, VEGF, CRP level and discrepancy rate of gastric neoplastic lesions (10 low-grade dysplasias, 18 high-grade dysplasias, and 25 early gastic cancers).
Results
Serum levels of IL-6 in gastric adenoma and mucosal cancer patients were significantly higher than in healthy controls (p＜0.05). Especially, serum IL-6 level of high-grade dysplasia patient was significantly higher than low-grade dysplasia and mucosal cancer patients, and the positive rate, sensitivity, and negative predictive value of serum IL-6 levels were higher in high-grade dysplasia patient compared to low-grade dysplasia patient and mucosal cancer patient. Serum levels of VEGF in patients with gastric adenoma and mucosal cancer were significantly higher than healthy controls (p＜0.01). Serum levels of CRP in patients with mucosal cancer were significantly higher than in the controls (p＜0.05), and the positive rate, sensitivity, and positive predictive value of serum CRP levels were higher in high-grade dysplasia and mucosal cancer patients compared to low-grade dysplasia patient.
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Fig. 1.
Pathologic findings after endoscopic sbumucosal dissection: low-grade dysplasia (A), high-grade dysplasia (B), and mucosal cancer (C) (H&E stain, ×400).
Fig. 2.
Serum levels of IL-6 in controls, gastric adenoma and mucosal cancer patients. LGD, low-grade dysplasia; HGD, high-grade dysplasia; EGC, early gastric cancer.
Fig. 3.
Serum levels of VEGF in controls, gastric adenoma and mucosal cancer patients. LGD, low-grade dysplasia; HGD, high-grade dysplasia; EGC, early gastric cancer.
Fig. 4.
Serum levels of CRP in controls, gastric adenoma, and mucosal cancer patients. LGD, low-grade dysplasia; HGD, high-grade dysplasia; EGC, early gastric cancer.
Table 1.
Dermographic Data of Patients
| LGD | HGD | M cancer | Control | |
|---|---|---|---|---|
| No. of patients | 10 | 18 | 25 | 60 |
| Age | ||||
| Median (range) | 61.5 | 61.7 | 59.6 | 58.1 |
| (40-68) | (42-69) | (37-76) | (34-75) | |
| Sex | ||||
| Male | 6 | 10 | 15 | 37 |
| Female | 4 | 8 | 10 | 23 |
Table 2.
Serum Levels of IL-6, VEGF, CRP in the Controls, Adenoma, Cancer Groups
Table 3.
Serum Levels of IL-6 in the Controls, Adenoma, Cancer Groups according to Age
Table 4.
Positive Rate of Serum IL-6, VEGF, CRP in Gastric Adenoma Patients and Cancer Patients
Table 5.
The Sensitivity and Specificity of Three Parameters in Patients with Gastric Adenoma and Cancer Patients
| IL-6 | VEGF | CRP | |
|---|---|---|---|
| Sensitivity (%) | |||
| LGD | 60.0 | 100 | 10.0 |
| HGD | 77.8 | 100 | 77.8 |
| M cancer | 44.0 | 100 | 60.0 |
| Specificity (%) | |||
| LGD | 20.0 | 63.3 | 60.0 |
| HGD | 20.0 | 63.3 | 60.0 |
| M cancer | 20.0 | 63.3 | 60.0 |
Table 6.
The Positive Predictive Value and Negative Predictive Value of Serum IL-6, VEGF, CRP in Gastric Adenoma and Cancer Patients
| LGD | HGD | M cancer | ||||
|---|---|---|---|---|---|---|
| PPV (%) | NPV (%) | PPV (%) | NPV (%) | PPV (%) | NPV (%) | |
| IL-6 | 11.00 | 75.00 | 22.58 | 75.00 | 18.33 | 50.00 |
| VEGF | 31.25 | 100 | 45.00 | 100 | 53.19 | 100 |
| CRP | 4.00 | 80.00 | 36.84∗ | 90.00 | 38.46∗ | 78.26 |
Table 7.
The Probability of Serum IL-6, VEGF, CRP in Gastric Adenoma and Cancer Patients
| Probability (%) | |||
|---|---|---|---|
| LGD | HGD | M cancer | |
| IL-6 | 25.71 | 33.33 | 12.94 |
| VEGF | 68.57 | 71.80 | 74.12 |
| CRP | 60.00 | 73.53 | 60.00 |
Table 8.
Serum Levels of VEGF in the Controls, Adenoma Cancer Groups according to Age
Table 9.
Serum Levels of CRP in Controls, Adenoma, Cancer Groups According to Age
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