循环肿瘤细胞检测在晚期乳腺癌化疗疗效评价中的价值探讨  

Study on the value of circulating tumor cells detection in the evaluation of chemotherapy efficacy of advanced breast cancer

作　　者：江秋晨 杨大伟 解磐磐[1] 张伟[1] 杨永瑞 崔兆清[1] Jiang Qiuchen;Yang Dawei;Xie Panpan;Zhang Wei;Yang Yongrui;Cui Zhaoqing(Department of Breast,Thyroid and Hernia Surgery,Liaocheng People’s Hospital,Liaocheng 252000,China;Zhongyuan Biomedical Research Institute,Liaocheng People’s Hospital,Liaocheng 252000,China;Graduate School,Shandong First Medical University,Taian 271000,China)

机构地区：[1]聊城市人民医院乳腺、甲状腺及疝外科,252000 [2]聊城市人民医院中原生物医学研究院,252000 [3]山东第一医科大学研究生部,泰安271000

出　　处：《中华普通外科学文献（电子版）》2020年第1期19-22,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨循环肿瘤细胞(CTC)在晚期乳腺癌患者化疗疗效评估中的价值。方法选取2016年7月至2018年6月聊城市人民医院乳腺中心确诊为晚期乳腺癌的患者50例,通过免疫磁珠阴性富集CTC、免疫荧光原位杂交(FISH)鉴定CTC,得出晚期乳腺癌患者化疗期间外周血中CTC的数目。收集患者影像学及血清学指标资料,比较患者化疗期间CTC数目的变化,并与影像学及血清学指标进行对比。结果18例(36.0%)首次CTC≥5个,28例(56.0%)≥1个,4例(8.0%)未发现CTC;化疗后CTC数目减少者32例,增加者18例。CTC与影像学指标变化基本一致,而且CTC计数改变与影像学指标在评估疾病变化过程中未见明显差异(kappa=0.65,χ^2=0.125,P=0.724);血清学指标在晚期乳腺癌病情发展过程中的变化与影像学对比差异有统计学意义,CEA(kappa=0.19,χ^2=4.267,P=0.039),CK19(kappa=0.16,χ^2=6.667,P=0.010),CA15-3(kappa=0.01,χ^2=4.500,P=0.034)。结论CTC计数对于预测晚期乳腺患者病情发展有一定的临床价值,CTC计数改变在晚期乳腺癌患者中预测疾病进展风险比血清学指标更加敏感。Objective To investigate the value of circulating tumor cells(CTC)in evaluating the efficacy of chemotherapy in patients with advanced breast cancer.Methods Fifty patients with advanced breast cancer diagnosed in the Breast Center of Liaocheng People’s Hospital from July 2016 to June 2018 were selected.Negative enrichment,immunocytochemistry CD45 staining andfluorescence in situ hybridization(FISH)was used to identify,enumerate and characterize CTC during chemotherapy of advanced breast cancer patients,and the data of imaging and serological indexes were collected to compare the changes of CTC number during chemotherapy of patients and to compare with imaging and serological indexes.Results For the first time,there were 18 cases(36.0%)with CTC count 5,28 cases(56.0%)with CTC count 1,and 4 cases(8.0%)with no CTC.The number of CTC was decreased in 32 cases and increased in 18 cases.The changes of CTC and imaging indicators were basically the same,and there was no significant difference between the changes of CTC count and imaging indicators in evaluating disease changes(kappa=0.65,χ^2=0.125,P=0.724).The changes of serological indicators in the development of advanced breast cancer were statistically significant compared with those of imaging CEA(kappa=0.19,χ^2=4.267,P=0.039),CK19(kappa=0.16,χ^2=6.667,P=0.010),CA15-3(kappa=0.01,χ^2=4.500,P=0.034).Conclusion CTC counts have certain clinical value in predicting the disease progression of patients with advanced breast cancer,and changes in CTC counts are more sensitive than serological indicators in predicting the risk of disease progression for patients with advanced breast cancer.

关 键 词：肿瘤细胞 循环 乳腺肿瘤 化疗 敏感性 

分 类 号：R737.9[医药卫生—肿瘤]