循环游离DNA在晚期恶性肿瘤中的应用价值  

Circulating cell-free DNA in advanced malignant tumor

作　　者：万莉[1] 王金焱 徐瀚峰 张启佳 张全安 WAN Li;WANG Jin-yan;XU Han-feng;ZHANG Qi-jia;ZHANG Quan-an(Department of Oncology,Nanjing Second Hospital,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210003,China;不详)

机构地区：[1]南京中医药大学附属南京医院南京市第二医院肿瘤科,江苏南京210003 [2]南京医科大学附属江宁医院肿瘤科,江苏南京211100

出　　处：《中国临床研究》2021年第12期1610-1613,共4页Chinese Journal of Clinical Research

基　　金：江苏省自然科学基金(BK20161110)。

摘　　要：目的对比循环游离DNA(cfDNA)、常用肿瘤标记物在晚期恶性肿瘤中的变化,探讨cfDNA的临床应用价值。方法以南京市第二医院肿瘤科2020年1月至2020年12月收治的30例可进行影像学评估的晚期恶性肿瘤患者为对象进行回顾性研究,观察患者治疗过程中cfDNA、肿瘤标记物以及影像学的变化。通过对治疗前患者空腹静脉血cfDNA和肿瘤标记物(CEA、CA199、AFP、NSE)的检测以及影像学(CT或MRI)评估,对比观察cfDNA与肿瘤标记物水平变化与影像学疗效评估的一致性。结果30例晚期恶性肿瘤患者中有25例在基线水平检测到cfDNA增高,检出率83.33%;体内肿瘤病灶的大小及数目与cfDNA水平呈正相关(r=0.084,P<0.01;r=0.580,P<0.01)。体内肿瘤负荷越大,cfDNA水平越高(P<0.05)。cfDNA与肿瘤标记物同向性变化者20例,异向性变化者8例,两周期抗肿瘤治疗后影像学检查评估显示:CR 0例,PR 3例,SD 22例,PD 5例。Spearman相关性分析结果表明,cfDNA持续增高与影像学检查评估的疾病控制率呈负相关(r=-0.553,P<0.01)。结论cfDNA对晚期恶性肿瘤的病情评估和疗效监测具有一定的预测作用,或可作为动态观察晚期恶性肿瘤病情变化的一个血清学肿瘤标记物。Objective To compare the changes of circulating free DNA(cfDNA), common tumor markers in advanced malignant tumors, and to explore the clinical value of cfDNA. Methods A retrospective study was conducted on 30 patients with advanced malignant tumors who could be evaluated by imaging in the oncology department of Nanjing Second Hospital from January 2020 to December 2020, to observe the changes of cfDNA, tumor markers and imaging features during the treatment. Through the detection of serum cfDNA and tumor markers [carcinoembryonic antigen(CEA), cancer antigen(CA)199, alpha-fetoprotein(AFP), neuron specific enolase(NSE)] and the imaging evaluation(CT or MRI) before treatment, the consistency was observed between the changes of cfDNA and the levels of tumor markers and imaging evaluation in monitoring treatment efficacy. Results The cfDNA levels were increased in 25 of 30 patients with advanced malignant tumor at baseline(detectable rate 83.33%) and positively correlated with the size(r=0.804,P<0.01) and number of tumor lesions(r=0.580,P<0.01). The higher the tumor load in vivo, the higher the cfDNA level(P<0.05).The levels of cfDNA and the levels of tumor markers changed in the same direction in 20 cases and changed in the opposite direction in 8 cases. After two cycles of anti-tumor therapy, imaging evaluation showed no case of complete response(CR), 3 cases of partial response(PR), 22 cases of stable disease(SD) and 5 cases of progressive disease(PD). Spearman correlation analysis showed that the continuous increase of cfDNA was negatively correlated with the disease control rate by imaging evaluation(r=-0.553, P<0.01). Conclusion The cfDNA has a certain predictive effect on the disease assessment and curative effect evaluation, and can be used as a serological biomarker to dynamically observe the changes of advanced malignant tumors.

关 键 词：循环游离DNA 恶性肿瘤 血清肿瘤标记物 影像学 

分 类 号：R730.4[医药卫生—肿瘤]