乳腺癌外周血循环肿瘤细胞变化与新辅助化疗效果的关系  

Relationship of peripheral blood circulating tumor cells with therapeutic effect of neoadjuvant chemotherapy in breast cancer:report of 70 cases

作　　者：王明浩[1] 杨新华[1] 张毅[1] 范林军[1] 张帆[1] 齐晓伟[1] 李世超[1] 孙鹏[1] 姜军[1] 

机构地区：[1]第三军医大学西南医院乳腺疾病中心,重庆400038

出　　处：《第三军医大学学报》2013年第11期1148-1151,共4页Journal of Third Military Medical University

基　　金：第三军医大学临床科研基金(2010XLC03;SWH2012LC03)~~

摘　　要：目的探讨乳腺癌患者外周血中循环肿瘤细胞(circulating tumor cells,CTC)变化情况与新辅助化疗(neoadju-vant or primary chemotherapy,NCT)疗效的关系。方法抽取70例乳腺癌患者NCT前后健侧上肢静脉血5mL,利用密度梯度离心法富集血标本中单个核细胞,通过荧光定量RT-PCR技术检测所获得单个核细胞中细胞角蛋白-19(cytokeratin-19,CK-19)阳性的CTC数目。结果NCT前外周血CTC检出率为24.29%(17/70),与患者年龄(P=0.008)及HER-2(P=0.022)表达情况有关。根据NCT前后CTC检测情况,将患者分为阳性-阳性、阳性-阴性、阴性-阳性及阴性-阴性4组,以RECIST标准评估NCT疗效时,4组有效率依次为66.67%(2/3)、78.57%(11/14)、0(0/4)和71.43%(35/49),差异具有统计学意义(P=0.023);以Miller-Payne标准评估NCT疗效时,4组有效率依次为66.67%(2/3)、71.43%(10/14)、0(0/4)和69.39%(34/49),差异具有统计学意义(P=0.043)。结论NCT前后CTC的变化情况与疗效有一定关系,CTC可作为评估NCT疗效的潜在预测指标。Objective To investigate the relationship between the alterations of circulating tumor cells （CTC） in peripheral blood and the curative effect of neoadjuvant chemotherapy for breast cancer. Methods A total of 70 patients with confirmed lateral breast infiltrating ductal carcinoma without obvious metastasis hospitalized in our department from March 2010to September 2011 were enrolled in this study. Venous blood samples of 5 ml were collected from their upper limb of health side before and after 2 to 6 cycles of TE regimen as neoadjuvant chemotherapy （paclitaxel 175 mg/m2, epirubicin 60 mg/m2, d1, 21 d/cycle）. Density gradient centrifugation was used to enrich mononuclear cells in blood specimens. Fluorescence quantitative RT-PCR was used to detect the mononuclear cells positive to cytokeratin-19 （CK-19）. Results Before neoadjuvant chemotherapy, 24.29% patients （17/70） had CTC detected, which was related with age （P=0.008） and HER-2 expression （P=0.022）. According to the result of having CTC detected or not before and after chemotherapy, the patients were divided into 4 groups, that is, positive to positive, positive to negative, negative to positive and negative to negative groups. When the Response Evaluation Criteria in Solid Tumors （RECIST） criteria was used to evaluate the efficiency of neoadjuvant chemotherapy, it was 66.67% （2/3）, 78.57% （11/14）, 0 （0/4） and 71.43% （35/49） respectively for the above 4 groups with significant difference（P=0.023）. When the efficiency was evaluated by the Miller-Payne grading system, it was 66.67% （2/3）, 71.43% （10/14）, 0（0/4） and 69.39% （34/49） respectively for the above 4 groups with significant difference（P=0.043）. Conclusion The alteration of CTC before and after chemotherapy has a certain relationship with efficiency of neoadjuvant chemotherapy. CTC can be regarded as a predictor for evaluating neoadjuvant chemotherapy.

关 键 词：乳腺肿瘤 新辅助化疗 循环肿瘤细胞 

分 类 号：R730.43[医药卫生—肿瘤] R730.53[医药卫生—临床医学]