术中腹腔游离癌细胞检测用于胃癌TNM分期  

A new TNM staging system inclusive of intraoperitoneal free cancer cells in gastric cancer patients

作　　者：张岩松[1] 王荣朝[1] 董雪伟[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,江苏省常州213003 [2]苏州大学附属第三人民医院综合实验室,江苏省常州213003 [3]瑞典LUND大学医学院临床化学研究所

出　　处：《中华普通外科杂志》2009年第11期934-936,共3页Chinese Journal of General Surgery

摘　　要：目的探讨术中腹腔游离癌细胞的检测在胃癌TNM分期中的应用。方法用实时荧光RT-PCR方法检测胃癌患者术中腹腔游离癌细胞（freecancer cell，FCC），并进行5年的随访。用MedCale软件分析FCC最佳阳性判定值，大于此值表示FCC的存在，标记为FCC（＋），然后把FCC（＋）当作远处转移（MI）重新进行分期，并作新的生存曲线图。结果（1）在最佳阳性判定值为31．21拷贝／ml时约登指数最高；（2）把FCC（＋）、当作MI重新进行分期，各分期之间的5年生存曲线显示：Ⅰ～Ⅱ期P=0．134；Ⅱ～Ⅲ期P=0．004；Ⅲ～Ⅳ期P=0．022。新分期各分期的5年生存率分别为Ⅰ期100％（18／18），Ⅱ期88％（7／8），Ⅲ期24％（4／17），Ⅳ期9％（2／22）。结论（1）FCC最佳阳性判定值为31．21拷贝／ml；（2）现行TNM分期中加入FCC检测结果则可使其更加完善，能更准确地评估进展期胃癌患者的手术预后。Objective To evaluate a new TNM staging system inelusive of intraperitoneal free cancer cells in terms of postoperative survival of patients with gastric cancer. Methods Free cancer cells （FCC） in the peritoneal washes of gastric cancer patients were estimated by measuring CEA mRNA levels using real-time RT-PCR. After 5-year follow-up, we get the cut-off value of CEA mRNA level by using MedCalc software to analyze the ROC curve. When CEA levels are more than the cut-off value, it may considered as FCC（ ＋ ） , and then using FCC（ ＋ ） as distant metastasis （ MI ） to make a new TNM staging and analyze patients life-span. Results （ 1 ） Under the ROC curve analysis, when the cut-off value of CEA mRNA level was at 31.21 copies/ml, the Youden＇ s index is the highest. （2） When FCC （ ＋ ） considered as M1 to make a new TNM staging, the 5-year survival rate showed as below： Ⅰ -Ⅱ , P = 0. 134; stage Ⅱ -Ⅲ P = 0. 004 and Ⅲ-Ⅳ P= 0. 022, repecetively. Conclusion （ 1 ） The best cut-off value of CEA mRNA levels for FCC in peritoneal washes is 3l. 2 copies/ml. （2） Our study demonstrated that application of FCC（ ＋ ） in the TNM staging may have a better estimation of prognosis of patients suffering from advanced gastric cancer.

关 键 词：胃肿瘤 肿瘤分期 预后 逆转录聚合酶链反应 游离癌细胞 

分 类 号：R686[医药卫生—骨科学]