Kumara H M C Shantha, Addison Poppy, Gamage Dasuni N, Pettke Erica, Shah Abhinit, Yan Xiaohong, Cekic Vesna, Whelan Richard L
Division of Colon and Rectal Surgery, Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY 10028, USA.
Nuvance Health, Vassar Brothers Medical Center, Poughkeepsie, NY 12601, USA.
Mol Clin Oncol. 2022 Feb;16(2):28. doi: 10.3892/mco.2021.2461. Epub 2021 Dec 8.
Plasminogen activator inhibitor-1 (PAI-1) is a serine protease inhibitor that inhibits urokinase-type plasminogen activator and tissue-type plasminogen activator. PAI-1 participates in angiogenesis, wound healing and tumor invasion, and additionally regulates endothelial cell proliferation, angiogenesis and tumor growth. The purpose of the present study was to measure plasma PAI-1 levels perioperatively in patients with colorectal cancer (CRC) undergoing minimally invasive colorectal resection (MICR). Patients with CRC who underwent elective MICR were eligible for the study. All patients were enrolled in an approved data/plasma bank. Patients with preoperative, postoperative day (POD) 1, POD 3, and at least one POD 7-34 plasma sample collection were studied. Plasma PAI-1 levels were determined in duplicate using ELISA, and the medians and 95% confidence intervals (CIs) were determined. The correlations between postoperative plasma PAI-1 levels and length of surgery were evaluated. PAI-1 levels were compared between patients who underwent laparoscopic-assisted vs. hand-assisted surgery. The preoperative PAI-1 levels of stage I, II, III and IV pathological stage subgroups were also compared. A total of 91 patients undergoing MICR for CRC were studied. The mean incision length was 8.0±3.9 cm, and the length of stay was 6.8±4.3 days. Compared with the median preoperative levels (17.30; 95% CI: 15.63-19.78 ng/ml), significantly elevated median levels were observed on POD 1 (28.86; 95% CI: 25.46-31.22 ng/ml; P<0.001), POD 3 (18.87; 95% CI: 17.05-21.78 ng/ml; P=0.0037), POD 7-13 (26.97; 95% CI: 22.81-28.74 ng/ml; P<0.001), POD 14-20 (25.92; 95% CI: 17.85-35.89 ng/ml; P=0.001) and POD 21-27 (22.63; 95% CI: 20.03-30.09 ng/ml; P<0.001). The PAI-1 levels in the hand-assisted group were higher compared with those in the laparoscopic-assisted group for 4 weeks after surgery; however, a significant difference was found only on POD 1. Therefore, plasma PIA-1 levels were found to be significantly elevated for 4 weeks after MICR, and the surgery-related acute inflammatory response may account for the early postoperative PIA-1 increase. Furthermore, PAI-1-associated VEGF-induced angiogenesis in the healing wounds may account for the late postoperative elevations, and increased PAI-1 levels may promote angiogenesis in residual tumor deposits.
纤溶酶原激活物抑制剂-1（PAI-1）是一种丝氨酸蛋白酶抑制剂，可抑制尿激酶型纤溶酶原激活物和组织型纤溶酶原激活物。PAI-1参与血管生成、伤口愈合和肿瘤侵袭，此外还调节内皮细胞增殖、血管生成和肿瘤生长。本研究的目的是测量接受微创结直肠切除术（MICR）的结直肠癌（CRC）患者围手术期的血浆PAI-1水平。接受择期MICR的CRC患者符合本研究条件。所有患者均被纳入一个已获批准的数据/血浆库。对术前、术后第1天（POD 1）、POD 3以及至少一份POD 7 - 34的血浆样本进行采集的患者进行研究。使用酶联免疫吸附测定法（ELISA）对血浆PAI-1水平进行双份测定，并确定中位数和95%置信区间（CIs）。评估术后血浆PAI-1水平与手术时长之间的相关性。比较接受腹腔镜辅助手术与手辅助手术患者之间的PAI-1水平。还比较了病理分期为I期、II期、III期和IV期亚组的术前PAI-1水平。共对91例接受CRC的MICR患者进行了研究。平均切口长度为8.0±3.9厘米，住院时长为6.8±4.3天。与术前中位数水平（17.30；95% CI：15.63 - 19.78纳克/毫升）相比，在POD 1（28.86；95% CI：25.46 - 31.22纳克/毫升；P<0.001）、POD 3（18.87；95% CI：17.05 - 21.78纳克/毫升；P = 0.0037）、POD 7 - 13（26.97；95% CI：22.81 - 28.74纳克/毫升；P<0.001）、POD 14 -
