循环肿瘤细胞动态变化对转移性乳腺癌患者治疗反应及预后的预测价值  

Prediction value for dynamic changes of circulating tumor cell in therapeutic response and prognosis of Chinese metastatic breast cancer patients

作　　者：边莉[1] 刘毅[2] 王涛[1] 张少华[1] 邵志敏[3] 佟仲生[4] 宋尔卫[5] 王晓稼[6] 廖宁[7] 江泽飞[1] 

机构地区：[1]军事医学科学院附属医院乳腺肿瘤内科,北京100071 [2]军事医学科学院附属医院肿瘤学研究室,北京100071 [3]复旦大学附属肿瘤医院乳腺外科 [4]天津市肿瘤医院乳腺肿瘤内科 [5]中山大学孙逸仙纪念医院乳腺外科 [6]浙江省肿瘤医院化疗中心乳腺肿瘤内科 [7]广东省人民医院乳腺科

出　　处：《中华医学杂志》2014年第4期265-268,共4页National Medical Journal of China

摘　　要：目的探讨循环肿瘤细胞（CTC）动态变化对中国转移性乳腺癌患者治疗反应及预后的预测价值。方法自2010年3月至2011年1月从中国6个乳腺肿瘤中心共入选300例转移性乳腺癌患者，在转移性乳腺癌患者开始新的全身治疗前（基线）、治疗3～4周以及6～8周通过CellSearch系统进行外周血CTC检测。用Kaplan-Meier方法绘制无进展生存（PFS）曲线，通过Log-Rank检验分析CTC动态变化对PFS改善的提示作用。结果中位随访36．86周。基线CTC≥5个／7．5ml、在治疗3～4周时CTC数目降低至〈5个／7．5ml的患者的中位PFS时间比CTC持续≥5个／7．5ml的患者显著延长（30．4比14．1周，P=0．010），并且与基线CTC〈5个／7．5ml的患者差异无统计学意义（30．4比42．0周，P=0．780）。治疗6～8周时各组PFS比较结果与治疗3～4周时一致，基线CTC≥5个／7．5ml、在治疗6～8周时CTC数目降低至〈5个／7．5ml的患者的中位PFS时间比CTC持续≥5个／7．5ml的患者显著延长（33．4比8．9周，P=0．000），并且与基线CTC〈5个／7．5ml的患者差异无统计学意义（33．4比42．0周，P=0．950）。结论CTC动态变化能够预测患者疾病进展风险的改善，在治疗监测中具有重要意义。Objective To explore the prediction value for dynamic changes of circulating tumor cell （CTC） in therapeutic response and prognosis of Chinese metastatic breast cancer patients. Methods A total of 300 metastatic breast cancer patients from six breast cancer centers in China were included from March 2010 to January 2011. The CTC levels of metastatic breast cancer patients were detected with a CellSearch system before starting a new systemic therapy （baseline） and after 3 -4, 6 -8 weeks. The progression-free survival （PFS） of different groups according to dynamic changes of CTC was estimated by the Kaplan-Meier method and compared with Log-Rank test. Results The median follow-up time was 36. 86 weeks. The median PFS of patients with ≥5 CTCs/7.5 ml at baseline but with 〈5 CTCs/7.5 ml after treatment of 3 - 4 weeks was significantly prolonged than that those with persistent ≥ 5 CTCs/7.5 ml at the same timepoint （30.4 vs 14. 1 weeks, P = 0. 010）. Furthermore, the median PFS of former had no significant statistic difference with those with 〈 5 CTCs/7.5 ml at baseline （ 30. 4 vs 42.0 weeks, P = 0. 780 ）. The analysis result of PFS for three groups according to CTC of 6 - 8 weeks treatment was consistent with that according to CTC of 3 - 4 weeks. The median PFS of patients with ≥ 5 CTCs/7.5 ml at baseline but with 〈 5 CTCs/7.5 ml after treatment of 6 - 8 weeks was significantly prolonged than that those with persistent ≥ 5 CTCs/7.5 ml at the same time point （33.4 vs 8.9 weeks, P =0. 000）. The median PFS of former had no significant statistic difference with those with 〈 5 CTCs/7.5 ml at baseline （ 33.4 vs 42. 0 weeks, P = 0. 950）. Conclusion The dynamic changes of CTC levels during therapy may predict an improvement of progression disease risk and has significance in therapeutic efficacy monitoring.

关 键 词：肿瘤细胞 循环 乳腺肿瘤 肿瘤转移 预后 

分 类 号：R737.9[医药卫生—肿瘤]