循环肿瘤DNA检测对胃癌患者疾病进展和肿瘤复发的预测价值  

Predictive Value of Circulating Tumor DNA Detection for Disease Progression and Tumor Recurrence in Patients with Gastric Cancer

作　　者：曹俊英 张应华 李婷[1] CAO Jun-ying;ZHANG Ying-hua;LI Ting(Department of Gastrointestinal Surgery,Yingcheng Hospital of Central South Hospital of Wuhan University,Yingcheng 432400,China)

机构地区：[1]武汉大学中南医院应城医院胃肠外科,湖北应城432400

出　　处：《南昌大学学报（医学版）》2023年第3期29-33,43,共6页Journal of Nanchang University：Medical Sciences

基　　金：湖北省卫计委科研项目(WJ2017MB260)。

摘　　要：目的探讨循环肿瘤DNA(ctDNA)检测对胃癌患者疾病进展和肿瘤复发的预测价值。方法收集154例胃癌患者术前、术后7 d及术后每3个月至2年的血液样本。采用二代测序(NGS)(Panel检测)或微滴数字聚合酶链式反应(ddPCR)分析血浆样本中ctDNA突变情况。结果Panel检测结果显示,ctDNA突变总检出率为73.4%(113/154),共发现207个基因突变,以TP53(68.1%,77/113)基因突变最为常见,其次为KRAS(27.4%,31/113)、APC(17.7%,20/113)、PIK3CA(14.16%,16/113)、GNAS(9.73%,11/113)。随后对63例患者术后样本进行ddPCR分析,在4例术后肿瘤复发患者中,ctDNA突变检测术前均为阳性,术后7 d阳性3例,ctDNA突变阳性患者复发率为75.0%。根据术后7 d时ctDNA突变水平,ctDNA突变阳性患者无复发生存期显著短于ctDNA突变阴性患者(HR:14.91;95%CI:0.72~313.45;P<0.001)。结论通过液体活检检测ctDNA突变有助于识别术后复发高风险患者,且ctDNA连续检测有助于早期发现肿瘤复发。Objective To explore the predictive value of circulating tumor DNA(ctDNA)detection for disease progression and tumor recurrence in patients with gastric cancer.Methods The blood sampleswere collected from 154 patients with gastric cancerbefore operation,7 days after operation,and every 3 months to 2 years after operation.Next generation sequencing(panel testing)or microdrop digital PCR(ddPCR)were used to analyze ctDNA mutations in plasma samples.Results Panel testing showed that the total detection rate of ctDNA mutations was 73.4%(113/154).A total of 207 gene mutations were found,of which TP53(68.1%,77/113)gene mutations were the most common,followed by KRAS(27.4%,31/113),APC(17.7%,20/113),PIK3CA(14.16%,16/113),and GNAS(9.73%,11/113).Then,ddPCR analysis was carried out inthe postoperative samples of 63 patients.Among the 4 patients with postoperative tumor recurrence,ctDNA mutations were positive before operation,and the recurrence rate of patients with ctDNA mutations was 75.0%(3/4)at 7 days after operation.According to the ctDNA mutation levels at 7 days after operation,the relapse-free survival time of ctDNA-positive patients was significantly shorter than that of ctDNA-negative patients(HR:14.91,95%CI:0.72-313.45,P<0.001).Conclusion Detection of ctDNA mutations by liquid biopsy is helpful to identify patients with high risk of postoperative recurrence,and continuous determination of ctDNA is helpful for early detection of tumor recurrence.

关 键 词：循环DNA 胃癌 液体活检 突变 复发 

分 类 号：R735.2[医药卫生—肿瘤]