广泛期小细胞肺癌胸部放疗患者循环肿瘤细胞临床价值的探索性研究  

Preliminary study of clinical role of circulating tumor cell in patients with extensive stage small cell lung cancer treated by thoracic radiotherapy

作　　者：张烨 惠周光 张文 冯林 张开泰 邓垒 王文卿 周宗玫 王绿化 ZHANG Ye;HUI Zhouguang;ZHANG Wen;FENG Lin;ZHANG Kaitai;DENG Lei;WANG Wenqing;ZHOU Zongmei;WANG Lvhua(Department of Radiation Oncology;Department of VIP Medical Services;Department of Immunology,＇State Key Laboratory of Molecular Oncology,National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院特需医疗部,北京100021 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院免疫学研究室,北京100021 [4]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院分子肿瘤学国家重点实验室,北京100021

出　　处：《癌症进展》2018年第7期828-833,共6页Oncology Progress

基　　金：国家自然科学基金面上项目(81572971);国家重点研发计划项目(2017YFC1311000);首都临床特色应用研究(Z171100001017114);中国医学科学院基本科研业务费(JK2014B16;2016ZX310012)

摘　　要：目的初步探讨循环肿瘤细胞(CTC)对接受胸部放疗的广泛期小细胞肺癌(SCLC)患者疗效预测和预后的意义。方法选取16例广泛期SCLC患者为研究对象。在胸部放疗前后,采用o HSV1-h TERT-GFP技术检测CTC。比较胸部放疗前后不同CTC数目患者的无疾病进展生存期和总生存期。结果 16例广泛期SCLC患者中,1例患者胸部放疗后失访,仅15例患者纳入分析。胸部放疗前基线水平的CTC中位数目为27/4 ml[(6~50)/4 ml],胸部放疗后的CTC中位数目为11/4 ml[(1~23)/4 ml]。多因素线性回归分析显示:CTC数目与广泛期SCLC患者的年龄、性别、吸烟、TNM分期、是否单脏器转移及转移病灶数目均无关(P﹥0.05)。入组患者中位随访时间为35.5个月(6.0~42.2个月)。胸部放疗前CTC≥27/4 ml患者的中位无疾病进展生存时间和中位总生存时间均短于CTC﹤27/4 ml的患者,但差异均无统计学意义(P﹥0.05);胸部放疗后CTC≥11/4 ml患者的中位无疾病进展生存时间和中位总生存时间均明显短于CTC﹤11/4 ml的患者(P﹤0.01)。6例胸部放疗后CTC≥11/4 ml的患者均复发,9例胸部放疗后CTC﹤11/4 ml的患者中仅3例复发。散点图显示随着CTC数目增加,患者的无疾病进展时间和总生存时间均明显缩短。结论一线化疗有效的广泛期SCLC患者接受胸部放疗后的CTC水平与患者预后有关,但需要进一步大样本的研究证实。Objective To investigate the prognostic and predictive value of circulating tumor cell（CTC） in patients with extensive stage small cell lung cancer（SCLC） underwent thoracic radiotherapy. Method Blood samples for CTC analysis were obtained from 16 patients with extensive stage SCLC before and after thoracic radiotherapy and CTC were assessed with o HSV1-h TERT-GFP system. The numbers of CTC before and after thoracic radiotherapy were compared and progression-free survival（PFS） and overall survival（OS） were analyzed. Result Among 16 patients with extensive stage SCLC, 1 patient lost after thoracic radiotherapy and only 15 patients were enrolled for final analysis. The median CTC count was 27/4 ml [range,（6-50）/4 ml] at baseline before thoracic radiotherapy and was 11/4 ml [（range,（1-23）/4 ml）] after thoracic radiotherapy. Multiple factor linear regression showed the CTC count was not associated with the clinical parameters, including age, gender, smoking, TNM stage, metastasis and the number of metastatic lesion（P〉0.05）. The median follow-up time was 35.5 months（range 6.0-42.2 months）. Patients with ≥27/4 ml CTC before thoracic radiotherapy tended to show worse PFS and OS than those with 〈27/4 ml CTC before thoracic radiotherapy,without significant difference（P〉0.05）. Patients with ≥11/4 ml CTC after thoracic radiotherapy had a worse PFS and OS than those with 〈11/4 ml CTC after thoracic radiotherapy（P〈0.05）. All 6 patients with ≥11/4 ml CTC after thoracic radiotherapy relapse, but only 3 relapsed in 9 patients with 〈11/4 ml CTC after thoracic radiotherapy. The scatter grams showed that the increase of CTC count before and after thoracic radiotherapy were associated with poorer PFS and OS.Conclusion CTC counts after thoracic radiotherapy is associated with the prognosis of patients with extensive stage SCLC after thoracic radiotherapy. However, studies of large-scale samples are needed for validation.

关 键 词：循环肿瘤细胞 小细胞肺癌 广泛期 放疗 预后 

分 类 号：R734.2[医药卫生—肿瘤]