放射治疗前后肺癌患者外周循环癌细胞的变化  

Fluctuation of circulating tumor cells in patients with lung cancer detected by real-time fluorescent quantitative-PCR approach before and after radiotherapy

作　　者：王梅[1] 葛明建[2] 

机构地区：[1]重庆医科大学附属第一医院检验科,重庆400016 [2]重庆医科大学附属第一医院胸外科,重庆400016

出　　处：《重庆医科大学学报》2010年第7期1063-1066,共4页Journal of Chongqing Medical University

基　　金：重庆市卫生局科研基金资助(编号:00-2004)

摘　　要：目的:通过实时荧光定量逆转录-聚合酶链反应法检测放射治疗前后肺癌患者外周循环癌细胞(Circulating tumour cells,CTCs)的改变,评估其作为新的疗效评定标准的可行性。方法:分别于放疗前后采集肺癌患者(n=30)外周血标本,同时摄胸片或CT扫描,并且计算肿瘤最大直径及垂直径的乘积。所有患者均接受原发灶及纵隔区域的常规分割放疗。运用fqRT-PCR法检测放射治疗前后患者外周血中CK19 mRNA拷贝数的改变。结果:与放疗前相比,放疗后患者外周血CK19 mRNA水平显著降低(5.0932±1.0628与4.2493±0.8323,t=3.192,P=0.007)。放疗前后CK19 mRNA水平变化与肺癌的组织类型(鳞/腺癌与小细胞癌)有密切关系(0.5389±1.0628与1.6826±0.9467,t=2.145,P=0.051),同时与癌肿分化等级(高/中分化与低分化)间也存在一定关系(0.5024与1.5271,t=2.017,P=0.065)。放疗前后CK19 mRNA水平变化与瘤负荷改变间存在相关性(r=0.575,P=0.025)。放疗前阳性率为80%(24/30),放疗后为53%(16/30),有8例病人经放疗后外周血CK19 mRNA表达转为阴性。结论:对于播散性癌细胞,仅行放疗是不够的,还需施以其它一些全身性辅助治疗措施,才可能取得较好疗效。可将治疗前后外周血中CTCs变化来作为实体瘤新的疗效评判标准。对外周血等处的播散癌细胞进行检测对肿瘤分期及预后评估具有参考价值。Objective：To evaluate the real-time fluorescent quantitative-polymerase chain reaction approach（fqRT-PCR） of cytokeratin 19（CK19）targets for its feasibility to estimate the number of circulating tumor cells（CTCs）in the patients with lung carcinoma during radiotherapy and to correlate our observation to clinical findings.Methods：Samples of 5ml peripheral blood were taken from each lung cancer patients（n=30）both before and after the radiotherapy course.Meanwhile tumour size was determined by chest X-ray or computed tomography.The blood samples were subjected to real time RT-PCR assay.All patients with lung cancer were treated with primary definitive and mediastinal radiotherapy.Results：Compared to with that before the-treatment,the value of CK19 mRNA in PB after therapy decreased dramaticall（y5.093 2±1.062 8 vs 4.249 3 ±0.832 3,t=3.192,P=0.007）.The change of CK19 mRNA level before and after radiotherapy was closely related to the typ（esquamous cell cancer/adenocarcinoma vs.small cell cancer,0.538 9±0.903 0 vs 1.682 6±0.946 7,t=2.146 5,P=0.051）.Meanwhile,there was a close link between the grade（Well/Mod vs Poor）and the change of CK19 mRNA（0.502 4 vs 1.527 1,t=2.017,P=0.065）.The change of CK19 mRNA level in peripheral blood（PB）was related to variation of tumour burden during radiotherapy（r=0.057 5,P=0.025）.Of the 30 cases studied,24 cases were positive before radiotherapy （24/30,80%）.The positive rate was 53%（16/30）after radiotherapy,meaning that 8 cases were converted intonegative after radiotherapy. Conclusion：The disseminated cancer cells cannot be completely eradicated by radiotherapy,suggesting further more systemic adjuvant treatment should be conducted.Early assessment of the therapeutic response might be possible by serial quantitative of CTCs.Detection of tumour cells disseminated in peripheral blood can provide clinically important data that are of value for tumour staging and possibly for prognostication.

关 键 词：肺肿瘤 血液 聚合酶链反应 细胞角蛋白 信使RNA 放射疗法 

分 类 号：R734.2[医药卫生—肿瘤]