循环肿瘤细胞与中晚期结直肠癌临床特征及生存的关系  

Relationship between circulating tumor cells(CTC) and clinical characteristics in intermediate and advanced colorectal cancer

作　　者：苟苗苗 张勇[1] 司海燕[1] 戴广海[1] GOU Miaomiao;ZHANG Yong;SI Haiyan;DAI Guanghai(Department of Oncology, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院第一医学中心肿瘤内科,北京100010

出　　处：《解放军医学院学报》2019年第2期117-120,共4页Academic Journal of Chinese PLA Medical School

基　　金：国家重点研发计划项目精准医学研究专项(2016YFC0905200);首都特色临床应用推广重点项目(Z161100000516003)~~

摘　　要：目的探究中晚期肠癌患者的临床特征与循环肿瘤细胞(circulating tumor cells,CTC)的相关性并进行生存分析。方法利用Cell SearchTM系统检测2017年1月-2018年7月本中心肿瘤内科收治的36例术后Ⅲ期结直肠癌患者辅助化疗前与45例晚期转移性结直肠癌患者化疗前CTC的表达计数,分析CTC表达与肿瘤分期、肿瘤部位、KRAS突变状态、肝转移、转移器官个数和肿瘤标记物的关系,及其对无进展生存时间(progession-free survival,PFS)的影响。结果Ⅲ期结直肠癌患者术后CTC阳性率为13.9%,晚期转移性结直肠癌患者CTC阳性率为44.4%,差异有统计学意义(P=0.003)。KRAS突变患者的CTC阳性率高于未突变的患者,差异有统计学意义(51.9%vs 21.2%,P=0.013)。肝转移患者CTC阳性率明显高于无肝转移患者(51.5%vs 16.7%,P=0.001),且转移灶≥2个者的阳性率高于转移灶<2的患者(44.1%vs21.3%,P=0.028)。肿瘤标记物CEA、CA199、血清铁蛋白高于正常值的患者CTC阳性率均高于肿瘤标记物正常的患者(45.2%vs15.4%,P=0.004;57.1%vs 27.1%,P=0.002;51.7%vs 19.2%,P=0.002)。45例晚期患者治疗后随访,CTC阴性组PFS略高于CTC阳性组,但差异无统计学意义(8.1个月vs 6.2个月,P=0.834)。结论循环肿瘤细胞与肿瘤负荷和生物标记物代谢相关,可用于临床评估肿瘤的生物学行为和预后。Objective To explore the correlation between clinical features, survival and circulating tumor cells(CTC) in advanced colon cancer. Methods The Cell SearchTM system was used to detect the expression of CTC from 36 patients with stage Ⅲ colorectal cancer after surgery and 45 patients with stage Ⅳ colorectal cancer before chemotherapy in our department from January 2017 to July 2018. The relationship of CTC expression with tumor staging, tumor location, KRAS mutation status, liver metastasis, number of metastatic organs, tumor markers, and progression-free survival were analyzed. Results The positive rate of CTC was 13.9% in stage Ⅲ and 44.4% in stage Ⅳ with statistically signi?cant difference(P=0.003);51.9% in KRAS mutation versus 21.2% in wide type(P=0.013);51.5% in patients with liver metastasis versus 16.7% in patients without metastasis(P=0.001);21.3% in patients with less than 2 metastatic organs and 44.1% in patients with more than 2 metastatic organs(P=0.028). The CTC positive rate in patients with higher level of tumor markers such as CEA, CA199, serum ferritin(SF) were signi?cantly higher than those in patients with the normal level(CEA, 45.2% vs 15.4%, P=0.004;CA199, 57.1% vs 27.1%, P=0.002;SF, 51.7% vs 19.2%, P=0.002). Forty-?ve patients in stage Ⅳ were followed up The PFS of CTC negative group was slightly higher than that of CTC positive group, without statistically signi?cant difference(8.1 months vs 6.2 months, P=0.834). Conclusion Circulating tumor cells are associated with tumor burden and tumor biomarker, which can be used to assess the biological behavior and prognosis in patients with intermediate and advanced colorectal cancer.

关 键 词：循环肿瘤细胞 结直肠癌 临床特征 疾病进展时间 

分 类 号：R735.3[医药卫生—肿瘤]