循环肿瘤细胞对直肠癌术前放化疗患者疗效及预后的评估价值  

The evaluation value of circulating tumor cells on the efficacy and prognosis of patients with rectal cancer undergoing radiotherapy and chemotherapy

作　　者：韦斌[1] 钟晓刚[1] 麦威[1] 黄顺荣[1] 牙韩清[1] 王晓通[1] Wei bin;Zhong Xiaogang;Mai Wei;Huang Shunrong;Ya Hanqing;Wang Xiaotong(Surgical Department of Gastrointestinal Hernia and Intestinal Fistula, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Province, Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院胃肠疝肠瘘外科,南宁530021

出　　处：《疑难病杂志》2021年第9期929-934,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z2015363,Z2016580)。

摘　　要：目的分析循环肿瘤细胞(CTC)对直肠癌术前放疗、化疗患者疗效及预后的评估价值。方法选择2016年9月—2019年6月广西壮族自治区人民医院胃肠疝肠瘘外科收治直肠癌患者136例,患者术前均行新辅助放、化疗,在治疗前检测CTC表达水平,并据此分成CTC阳性组和CTC阴性组,分析CTC表达与患者临床病理特征之间的关系。在新辅助治疗结束后,评估患者的治疗效果,并在术后随访18个月,评估患者的总生存率,比较不同疗效及预后患者CTC计数水平。绘制受试者工作特征曲线(ROC)分析CTC计数对疗效、预后的评估价值,经COX多因素分析模型分析患者预后的影响因素。结果136例患者中,CTC阳性率为61.8%(84/136),阴性率为38.2%(52/136)。CTC阳性组临床分期Ⅲ期、低分化占比分别为33.33%、30.95%,高于CTC阴性组的15.38%、11.54%(χ^(2)/P=20.737/0.000、6.728/0.009)。CTC阳性组总缓解率为33.33%,低于CTC阴性组的51.92%,且随访18个月时CTC阳性组总生存率为84.52%,低于CTC阴性组的96.15%(χ^(2)/P=4.608/0.032、4.427/0.035)。新辅助治疗后缓解患者CTC计数低于未缓解患者,随访18个月后生存患者CTC计数低于死亡患者(t/P=9.865/0.000,11.322/0.000)CTC计数评估患者新辅助治疗疗效、预后的曲线下面积(AUC)分别为0.764、0.794。COX多因素分析模型提示,临床分期、分化程度、CTC表达是直肠癌患者预后的影响因素[RR(95%CI)=2.525(1.365~4.671)、3.956(1.524~10.269)、2.468(1.298~4.693)]。结论CTC对直肠癌术前放、化疗患者疗效及预后具有较好的评估价值,且CTC表达是患者预后的影响因素。Objective To analyze the evaluation value of circulating tumor cells(CTC)for the efficacy and prognosis of patients with rectal cancer before surgery and chemotherapy.Methods From September 2016 to June 2019,136 patients with rectal cancer were admitted to the Department of Gastrointestinal Hernia and Intestinal Fistula,People's Hospital of Guangxi Zhuang Autonomous Region.All patients received neoadjuvant radiotherapy and chemotherapy before operation,and the expression level of CTC was detected before treatment.According to this,they were divided into CTC positive group and CTC negative group.Analyze the relationship between CTC expression and clinical pathological characteristics of patients.After the neoadjuvant treatment is over,evaluate the patient's treatment effect,and follow up for 18 months after surgery to evaluate the patient's overall survival rate.Compare the CTC count levels of patients with different efficacy and prognosis.A receiver operating characteristic curve(ROC)was drawn to analyze the evaluation value of CTC counts for curative effect and prognosis,and the influencing factors of patient prognosis were analyzed by COX multivariate analysis model.Results Among 136 patients,the positive rate of CTC was 61.8%(84/136)and the negative rate was 38.2%(52/136).The proportions of clinical stage III and poor differentiation in the CTC positive group were 33.33%and 30.95%,respectively,which were higher than 15.38%and 11.54%in the CTC negative group(χ^(2)/P=20.737/0.000,6.728/0.009).The overall response rate in the CTC positive group was 33.33%,which was lower than 51.92%in the CTC negative group,and the overall survival rate in the CTC positive group was 84.52%at a follow-up of 18 months,which was lower than 96.15%in the CTC negative group(χ^(2)/P=4.608/0.032,4.427/0.035).After neoadjuvant therapy,the CTC count of remission patients was lower than that of non-remission patients,and after 18 months of follow-up,the CTC count of surviving patients was lower than that of dead patients(t/P=9.865/0.000,1

关 键 词：直肠癌 循环肿瘤细胞 新辅助治疗 临床疗效 预后 

分 类 号：R735.37[医药卫生—肿瘤]