外周血循环肿瘤细胞检测在早期子宫颈浸润癌筛查中的临床价值  

Clinical Value of Peripheral Blood Circulating Tumor Cells Detection in Early Cervical Infiltrating Carcinoma Screening

作　　者：陈志强 米贤军 刘君[2] 苏年华[3] 叶才果 陈昂 段立锋 代新珍 徐秀梅 CHEN Zhi-qiang;MI Xian-jun;LIU Jun;SU Nian-hua;YE Cai-guo;CHEN Ang;DUAN Li-feng;DAI Xin-zhen;XU Xiu-mei(Department of Pathology,Zhongshan Boai Hospital Affiliated to SouthernMedical University,Zhongshan 528400,China;Department of Pathology,Sun Yat-sen University CancerCenter,Guangzhou 510060,China;Institute of Cancer Research,Zhongshan Hospital Affiliated to ZhongshanUniversity,Zhongshan 528403,China;Key Laboratory of Medical Molecular Diagnosis,Guangdong ProvinceAffiliated to Guangdong Medical University,Dongguan 523808,China)

机构地区：[1]南方医科大学附属中山博爱医院病理科,中山528400 [2]中山大学肿瘤防治中心病理科,广州510060 [3]中山大学附属中山医院肿瘤研究所,中山528403 [4]广东医科大学广东省医学分子诊断重点实验室,东莞523808

出　　处：《四川大学学报（医学版）》2019年第3期415-419,共5页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金(No.81572782);广东省医学科学技术研究基金立项课题(No.A2017321;No.B2019124);中山市社会公益科技研究专项立项(No.2018B1035);广东省中山市卫生和计划生育局医学科研立项课题(No.2017J111;No.2014J128)资助

摘　　要：目的观察不同程度子宫颈病变患者的外周血循环肿瘤细胞(circulating tumor cell,CTC)的差异,评估CTC检测在早期子宫颈浸润癌筛查中的效能。方法选择2015年12月至2017年10月中山市博爱医院、中山大学附属中山医院经组织病理和临床分期证实为子宫颈炎、子宫颈低级别与高级别鳞状上皮内病变(low-and high-grade intraepithelial lesions,LSIL、HSIL)、早期子宫颈浸润癌(4组)患者各63例,采用免疫磁珠阴性富集技术联合免疫荧光原位杂交技术(immunofluorescent in situ hybridization,imFISH)检测患者外周血CTC,分析4组患者CTC阳性率及数量差异,以组织病理诊断和临床分期结果为金标准,评价CTC检测结果阳性诊断早期子宫颈浸润癌的效能。结果 (1)子宫颈炎组、LSIL组、HSIL组、早期子宫颈浸润癌组患者CTC阳性率分别为0、0、19.05%、84.13%,总体差异有统计学意义(χ~2=504.00,P<0.05)。早期子宫颈浸润癌组CTC阳性率高于其他组,与其他组相比差异有统计学意义(P<0.008 3)。HSIL组CTC阳性率与LSIL、子宫颈炎组相比差异有统计学意义(P<0.008 3)。(2)子宫颈炎组、LSIL组、HSIL组、早期子宫颈浸润癌组患者的CTC阳性数(中位数)分别为0、0、1个/4 mL、3个/4 mL。早期子宫颈浸润癌组CTC阳性数高于其他组,与其他组比差异有统计学意义(P<0.008 3)。HSIL组平均CTC阳性数与LSIL、子宫颈炎组相比差异有统计学意义(P<0.008 3)。(3)CTC检测阳性结果诊断早期子宫颈浸润癌的灵敏度、特异度、符合率、阳性预测值和阴性预测值分别为84.13%、93.65%、91.27%、81.54%和94.65%。结论 CTC存在于HSIL和早期子宫颈浸润癌患者中,随着子宫颈病变程度的加重, CTC检测结果阳性率及数量均增加;CTC检测在早期子宫颈浸润癌筛查中具有一定的实用价值。Objective To observe the difference of circulating tumor cells(CTC)in peripheral blood ofpatients with different degrees of cervical lesions,and to evaluate the effectiveness of CTC detection in screeningearly invasive cervical cancer.Methods From December 2015to October 2017,63cases of cervicitis,low-grade andhigh-grade intraepithelial lesions(LSIL,HSIL)and early invasive cervical cancer were confirmed byhistopathological and clinical stages in Zhongshan Boai Hospital and Zhongshan Hospital Affiliated to ZhongshanUniversity.The immunomagnetic bead negative enrichment technique combined with immunofluorescence was used.In situ hybridization(imFISH)was used to detect CTC in peripheral blood of patients.The positive rate andquantity of CTC in four groups were analyzed.The diagnostic efficacy of CTC in early invasive cervical cancer wasevaluated based on the results of histopathological diagnosis and clinical staging.Results①The positive rates ofCTC in cervicitis group,LSIL group,HSIL group and early invasive cervical cancer group were 0,0,19.05%and84.13%respectively.The overall difference was statistically significant(χ^2=504.00,P<0.05).The positive rateof CTC in early invasive cervical cancer group was higher than that in other groups(P<0.008 3).The positive rates of CTC in HSIL group were significantly different from those in LSIL and cervicitis groups(P<0.008 3).②The average number(median)of CTC positive in cervicitis group,LSIL group,HSIL group and early invasive cervical cancer group was 0,0,1/4mL,3/4mL,respectively.The average number of positive CTC in early invasive cervical cancer group was higher than that in other groups,and the difference was significant compared with other groups(P<0.008 3).The average number of CTC positive in HSIL group was significantly different from that in LSIL and cervicitis group(P<0.008 3).③The sensitivity,specificity,coincidence rate,positive predictive value and negative predictive value of CTC positive results in the diagnosis of early invasive cervical cancer were 84

关 键 词：循环肿瘤细胞 子宫颈癌 子宫颈高级别鳞状上皮内病变 子低级别鳞状上皮内病变 

分 类 号：R737.33[医药卫生—肿瘤]