探讨结直肠癌患者术前血清miR-20a、miR-17水平在术后不良临床结局评估中的价值。

选择2013年8月至2016年2月华中科技大学同济医学院附属协和医院就诊的结直肠癌患者73例作为病例组，收集患者术前以及术后1周、1个月、3个月时的血清标本，另收集81名同期体检健康对照组的血清标本，采用实时荧光定量PCR法检测两组血清miR-20a、miR-17表达水平。根据表达平均数分为高表达组与低表达组，采用Kaplan-Meier法对两组进行生存分析；Cox比例风险回归模型筛选不良预后的影响因素，受试者工作特征（ROC）曲线分析血清miR-20a、miR-17水平对结直肠癌不良预后的诊断效能。

病例组患者术后血清miR-20a、miR-17水平呈下降趋势（P<0.05），且各检测点水平均高于对照组（P<0.05）。分化程度（HR=1.462，95% CI：1.096~1.951）、TNM分期（HR=1.642，95% CI：1.339~2.014）、术前血清miR-20a（HR=1.575，95% CI：2.035~3.652）、miR-17水平（HR=2.491，95% CI：2.131~2.914）是影响结直肠癌患者不良预后的独立危险因素（均P<0.001）。术前血清miR-20a、miR-17高表达者的3年总生存率更低（22.0% vs 78.3%，21.3% vs 73.1%，P<0.05）；两者联合检测预测结直肠癌患者预后不良的曲线下面积为0.955，敏感度为97.6%，特异度为91.2%。

结肠癌患者术前血清miR-20a、miR-17高表达与患者不良预后有关，术前检测有助于改善不良预后高风险患者的临床结局。

To investigate the value of preoperative levels of serum miR-20a and miR-17in the evaluation of adverse prognosis of patients with colorectal cancer.

From August 2013 to February 2016, seventy-three patients with colorectal cancer in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were selected as case group, and the serum samples were collected before operation, and 1 week, 1 month, 3 months after operation. Serum specimens of 81 healthy persons as control group were collected during the same period. According to the average level of miR-20a and miR-17 expression detected by fluorescent quantitation PCR, they were divided into high expression group and low expression group and survival analyzed by Kaplan-Meier method. Cox proportional hazard regression model was used to screen the influencing factors of poor prognosis. The diagnostic efficacy of miR-20a and miR-17 in the poor prognosis of colorectal cancer was analyzed by ROC curve.

The serum levels of miR-20a and miR-17 in the case group decreased after operation (P<0.05), and the levels of each detection point were higher than those in the control group (P<0.05). Differentiation (HR=1.462, 95% CI: 1.096-1.951), TNM stage (HR=1.642, 95% CI: 1.339-2.014), preoperative serummiR-20a level (HR=1.575, 95% CI: 2.035-3.652) and miR-17 level (HR=2.491, 95% CI: 2.131-2.914) were independent risk factors affecting the poor prognosis of colorectal cancer patients (all P<0.001). The 3-year overall survival rate of preoperative patients with high expression of serum miR-20a and miR-17 was lower (22.0% vs 78.3%, 21.3% vs 73.1%, P<0.05), and the area under the curve for predicting poor prognosis of patients with colorectal cancer was 0.955, the sensitivity was 97.6%, and the specificity was 91.2%.

The high expression of serum miR-20a and miR-17 in patients with colorectal cancer before operation is related to poor prognosis. Preoperative detection is helpful to improving the clinical outcomes of patients with high risk of poor prognosis.