乳腺癌患者循环肿瘤细胞检测的临床意义  

Clinical significance of circulating tumor cells detection in breast cancer patients

作　　者：龚福生[1,2] 黄伟炜[3] 刘健[3,2] 应敏刚[1,2] 郑秋红[1,2] 吴凡[3] 李娜妮[3] 陈侃[3] 宋云飞[4] 陈克秀[4] 张连伟[4] 

机构地区：[1]福建医科大学教学医院.福建省肿瘤医院肿瘤外科研究室,福建福州350014 [2]福建医科大学教学医院.福建省肿瘤医院.福建省肿瘤生物治疗重点实验室,福建福州350014 [3]福建医科大学教学医院.福建省肿瘤医院乳腺肿瘤内科,福建福州350014 [4]福建中医药大学研究生院第一临床医学院,福建福州350022

出　　处：《中华肿瘤防治杂志》2015年第13期1009-1013,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：福建省自然科学基金(2011J01141);福建省医学创新课题(2011-CX-16);福建省科技重点资助项目(2012Y0017)

摘　　要：目的探讨流式细胞术检测乳腺癌患者外周血循环肿瘤细胞(circulating tumor cells,CTCs)的临床意义。方法经梯度稀释后的乳腺癌细胞SKBR-3加入到正常人外周血单个核细胞中,以检验流式细胞术检测CTCs的敏感性。取福建省肿瘤医院2012-03-27-2012-12-26收治的62例乳腺癌患者和同期体检的20名健康女性志愿者7.5mL外周血,分离其单个核细胞,应用流式细胞术进行CTCs检测。结果流式细胞术检测CTCs的敏感性为10-6,特异性为100%。62例乳腺癌患者外周血CTCs阳性率为53.2%(33/62),20名健康女性志愿者CTCs均为阴性,差异有统计学意义,χ2=17.814,P<0.001。乳腺癌患者外周血CTCs阳性率与TNM分期(χ2=9.637,P=0.002)、Ki-67(χ2=7.839,P=0.005)和人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2,χ2=7.629,P=0.006)表达与否相关,而与月经状态、雌激素受体(estrogen receptor,ER)、孕激素受体(progestrone receptor,PR)表达与否无关。CTCs阳性率与乳腺癌患者分子亚型相关,χ2=16.862,P=0.001。化疗前乳腺癌患者CTCs阳性率为72.7%(24/33),化疗后CTCs阳性率为30.3%(10/33),差异有统计学意义,P=0.003。结论应用流式细胞术检测乳腺癌患者外周血CTCs具有较高的敏感性和特异性。乳腺癌患者外周血CTCs的阳性率与临床TNM分期、HER-2及Ki-67相关。乳腺癌分子亚型可能与外周血微转移的风险有关。OBJECTIVE To explore the clinical significance of circulating tumor cells（CTCs） in peripheral blood of breast cancer patients detected by flow cytometry（FCM）. METHODS The breast cancer cell line SKBR-3 was diluted in- to the mononuclear cells to test the sensitivity of FCM detection. Mononuclear cells were isolated from 7.5 mL peripheral blood of 62 Breast cancer patients and 20 healthy female volunteers using density gradient centrifugation. The CTCs were detected by FCM. RESULTS The sensitivity of FCM detection was 10-6 with specificity of 100%. The positive rate of CTCs in peripheral blood of breast cancer patients was 53.2% （33/62）, while CTCs were not detected in all healthy fe- male volunteers （0/20）. There was significant difference （X2 = 17. 814,P〈0. 001）. The presence of CTCs was correlated positively with TNM, Ki-67 and HER-2 （X2 =9. 673,P：0. 002; 2=7. 839, P=0. 005; （X2=7. 629,P：0. 006）, and ir- relevant with Menstrual status, ER and PR expression. The positive rate of CTCs in breast cancer patients was related with molecular subtype （z ： 16. 862, P= 0. 001）. The positive rate of CTCs in breast cancer patients was 72.7 % （24/33） before chemotherapy, and that were 30.3% （10/33） after chemotherapy. The difference has statistic significance （P： 0. 003）. CONCLUSIONS Detection of CTCs by FCM has high sensitivity and specificity. The positive rate of CTCs in peripheral blood of breast cancer patients is correlated with clinical TNM, HER-2 and Ki-67. Breast cancer molecular sub- types are possibly related with blood micrometastasis.

关 键 词：乳腺肿瘤 循环肿瘤细胞 流式细胞术 分子亚型 

分 类 号：R737.9[医药卫生—肿瘤]