临床误诊误治

目的 分析血清细胞骨髓细胞瘤病致癌基因（C-Myc）、程序性死亡配体-1(PD-L1)与胃癌TN分期的相关性及联合超声内镜对胃癌术前TN分期的诊断价值。方法 选取2019年1月至2024年1月收治的101例胃癌患者为胃癌组，术前均行超声内镜检查，统计超声内镜诊断胃癌TN分期的符合率；另选取同期就诊的101例胃炎患者为胃炎组，两组均检测血清c-Myc、PD-L1水平。比较两组血清c-Myc、PD-L1水平，比较不同TN分期胃癌患者血清c-Myc、PD-L1水平；分析血清c-Myc、PD-L1水平与TN分期的相关性；比较不同TN分期胃癌患者超声内镜病理特征；分析超声内镜联合血清c-Myc、PD-L1对胃癌术前TN分期的诊断价值。结果 胃癌术前超声内镜检查，T分期与病理结果符合率为82.18%(83/101),N分期与病理结果符合率为84.16%(85/101)。胃癌组血清c-Myc、PD-L1水平均高于胃炎组（P<0.05）；Ⅲ～Ⅳ期胃癌患者胃壁层次紊乱、胃腔狭窄变形、胃壁僵硬蠕动消失发生率高于Ⅰ～Ⅱ期（P<0.05）；Ⅲ期胃癌患者血清c-Myc、PD-L1水平高于Ⅰ、Ⅱ期，Ⅳ期胃癌患者血清c-Myc、PD-L1水平高于Ⅰ、Ⅱ、Ⅲ期（P<0.05）；血清c-Myc、PD-L1水平与胃癌TN分期均呈正相关（r=0.608、0.591,P<0.05）。超声内镜联合血清c-Myc、PD-L1诊断胃癌术前TN分期的受试者工作特征曲线的曲线下面积最大，为0.927(95%CI:0.858,0.969)。结论 胃癌患者血清c-Myc、PD-L1表达升高，且与TN分期相关，结合超声内镜与血清c-Myc、PD-L1可对胃癌术前TN分期做出较为准确的判断。

Objective Analysis of the Correlation between serum cellular myelocytomatosis oncogene(c-Myc),programmed death ligand-1(PD-L1) and TN staging of gastric cancer, and the diagnostic value of combined endoscopic ultrasonography(EUS) for preoperative TN Staging of gastric cancer. Methods In total, 101 patients with gastric cancer admitted from January 2019 to January 2024 were selected as the gastric cancer group. All patients underwent EUS before operation, and the coincidence rate of EUS in the diagnosis of gastric cancer TN staging was calculated. In addition, 101 patients with gastritis treated during the same period were selected as the gastritis group, and the serum levels of c-Myc and PD-L1 were detected in the two groups. The levels of serum c-Myc and PD-L1 in the two groups and the levels of serum c-Myc and PD-L1 in patients with different TN stages were compared. The correlation between serum levels of c-Myc and PD-L1 and TN stage was analyzed. The pathological characteristics of EUS in gastric cancer patients with different TN stages were compared. The diagnostic value of EUS combined with serum c-Myc and PD-L1 in preoperative TN staging of gastric cancer was analyzed. Results Preoperative EUS for gastric cancer showed that the coincidence rate of T staging and N staging with pathological results was 82.18%(83/101) and 84.16%(85/101), respectively. The serum levels of c-Myc and PD-L1 in the gastric cancer group were higher than those in the gastritis group(P<0.05).The incidence of gastric wall layer disorder, gastric cavity stenosis and deformation, gastric wall stiffness and disappearance of peristalsis in patients with stage Ⅲ-Ⅳ gastric cancer was higher than that in patients with stageⅠ-Ⅱ(P<0.05). The levels of serum c-Myc and PD-L1 in patients with stage Ⅲ gastric cancer were higher than those in stageⅠand Ⅱ, and the levels of serum c-Myc and PD-L1 in patients with stage Ⅳ gastric cancer were higher than those in stageⅠ, Ⅱ and Ⅲ(P<0.05). The serum levels of c-Myc and PD-L1 were positively correlated with TN staging of gastric cancer(r=0.608, 0.591, P<0.05). The area under the receiver operating characteristic(ROC) curve(AUC) of EUS combined with serum c-Myc and PD-L1 in the diagnosis of preoperative TN staging of gastric cancer was the largest, which was 0.927(95%CI: 0.858, 0.969)(P<0.05). Conclusion The expression of serum c-Myc and PDL1 in gastric cancer patients is increased, and is related to TN staging. The combination of EUS and serum c-Myc and PD-L1 can make a more accurate judgment of preoperative TN staging of gastric cancer.