胃癌术中腹腔游离癌细胞检测临界值的确定及其临床意义  

The optimal cut-off value of CEA mRNA level for detection of free cancer cells in peritoneal washes and its clinical significance

作　　者：董雪伟[1] 张岩松[1] 王荣朝[1] 许军[1] 李忠[1] 罗光华[2] 朱江[2] 徐宁 

机构地区：[1]苏州大学附属第三人民医院胃肠外科,江苏常州213003 [2]苏州大学附属第三人民医院综合实验室,江苏常州213003 [3]瑞典LUND大学医学院临床化学研究所,LUND瑞典21185

出　　处：《中国普通外科杂志》2009年第10期1009-1012,共4页China Journal of General Surgery

摘　　要：目的探讨胃癌术中腹腔游离癌细胞(FCC)检测的最佳阳性判定值,以及腹腔FCC的存在对预后的影响。方法用实时荧光RT-PCR方法检测术中腹腔FCC,并进行5年的随访。用MedCalc软件分析FCC最佳阳性判定值;[大于此值表示FCC存在,标记为FCC(+)],并前瞻性地分析FCC(+)组及(-)组与预后的关系。最后用多因素Cox回归模型分析影响预后的独立因素。结果(1)最佳阳性判定值为31.21拷贝/mL时约登指数最高;(2)FCC(+)与(-)组的平均存活期分别为17.2个月和48.7个月,中位存活期分别为8.1个月和60.0个月;5年累积存活率分别为9.1%和67.4%。Kaplan-Meier生存分析显示,FCC(-)组生存时间明显长于FCC(+)组(P=0.000)。Cox模型分析发现FCC,浆膜及远处转移是影响生存预后的独立因素(P<0.05)。结论(1)FCC最佳阳性判定值为31.21拷贝/mL;(2)腹腔FCC是影响预后的独立危险因素之一,FCC(+)反映手术时肿瘤存在扩散状态,预示患者预后较差。Objective To determine the optimal cut-off value of carcinoembryonic antigen （ CEA ） mRNA level for detection of free cancer cells （ FCC ） in peritoneal washes with real-time PCR and its clinical significance. Methods The CEA mRNA levels in peritoneal washes from 65 cases of gastric cancer were detected by real-time RT-PCR. After 5-year follow-up, cut-off value of CEA mRNA level was obtained with the ROC curve analysis and the relationship between FCC and prognosis with Kaplan-Meier method was studied. Results （ 1 ） With the ROC curve analysis, if the cut-off value of CEA mRNA level was31.21 , the Youden＇ s index was the highest. （ 2 ） The mean survival time （ months ） in group of FCC （ ＋ ） , （ - ） was 17.2 and 48. 7 months respectively, The median survival was 8. 1 and 60. 0 months, respectively, with significant difference （ P = 0. 000 ）. The 5 -year survival rate was 9. 1% and67.4% , respectively. Compared with FCC （ ＋ ） group, the FCC （ - ） group had significantly extended life span. COX regression showed that FCC was an independent prognostic factor. Conclusions （ 1 ） Our results suggest that the best cut-off value of CEA mRNA levels for detection of FCC in peritoneal washes is 3 1.2 copies/mL; （2） This study shows that FCC is an independent factor that affects prognosis. FCC （ ＋ ） denotes the presence of intraoperative tumor dissemination and predicts a poor prognosis.

关 键 词：胃肿瘤 游离癌细胞 实时荧光RT—PCR ROC曲线 预后 

分 类 号：R735.2[医药卫生—肿瘤]