外周血循环肿瘤细胞与胃癌患者临床病理特征及新辅助化疗疗效的关系  

Correlations of circulating tumor cells in peripheral blood with clinicopathological characteristics and effect of neoadjuvant chemotherapy on patients with gastric cancer

作　　者：白力允[1] 邢俊领[1] BAI Liyun;XING Junling(Department of Medical Oncology,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China)

机构地区：[1]新乡医学院第三附属医院肿瘤内科,河南新乡453003

出　　处：《新乡医学院学报》2024年第10期968-972,978,共6页Journal of Xinxiang Medical University

摘　　要：目的探讨外周血循环肿瘤细胞(CTC)与胃癌患者临床病理特征及新辅助化疗疗效的关系。方法选择2015年3月至2016年2月新乡医学院第三附属医院收治的112例胃癌患者为研究对象。所有患者均于治疗前1 d抽取空腹外周静脉血4 mL,采用阴性富集联合免疫荧光法检测外周血CTC,根据CTC检测结果将患者分为CTC阳性组和CTC阴性组。2组患者均给予新辅助化疗,奥沙利铂130 mg·m^(-2),静脉滴注,第1天;卡培他滨1000 mg·m^(-2),口服,每日2次,第1~14天;21 d为1个疗程,共治疗3个疗程。比较2组患者临床病例特征。采用Kappa检验分析实体瘤疗效评价标准(RECIST)和CTC数目评价标准的一致性,应用Kaplan-Meier生存分析计算患者3、5 a累积生存率,log-rank检验比较CTC阳性组和CTC阴性组患者治疗后3、5 a累积生存率。结果112例胃癌患者中,64例(57.14%)外周血CTC阳性,48例(42.86%)外周血CTC阴性。经新辅助化疗后,完全缓解、部分缓解、疾病稳定、疾病进展者分别为0例、76例、21例、15例,治疗总有效率为67.86%(76/112)。CTC阳性组患者肿瘤浸润深度、TNM分期与CTC阴性组比较差异有统计学意义(P<0.05);CTC阳性组与CTC阴性组患者的性别、年龄、病理分型、肿瘤大小、肿瘤位置、肿瘤分化程度、脉管癌栓比较差异均无统计学意义(P>0.05)。CTC阳性组患者治疗总有效率为59.38%(38/64),CTC阴性组患者治疗总有效率为79.17%(38/48);CTC阳性组患者治疗总有效率显著低于CTC阴性组(χ^(2)=4.926,P<0.05)。RECIST评价标准与CTC数目评价标准具有中度一致性(Kappa=0.546)。CTC阳性组患者3、5 a累积生存率分别为75.6%、26.7%,CTC阴性组患者3、5 a累积生存率分别为85.2%、46.6%。CTC阳性组患者3 a累积生存率与CTC阴性组比较差异无统计学意义(P>0.05);CTC阳性组患者5 a累积生存率显著低于CTC阴性组(P<0.05)。结论检测CTC有助于评估胃癌患者肿瘤浸润程度、临床分期,且能Objective To investigate the correlations between circulating tumor cells(CTCs)in peripheral blood and clinicopathological characteristics and the effect of neoadjuvant chemotherapy on patients with gastric cancer.Methods A total of 112 patients with gastric cancer admitted to the Third Affiliated Hospital of Xinxiang Medical University from March 2015 to February 2016 were selected as the research subjects.All patients were drawn 4 mL of fasting peripheral venous blood on the first day before treatment,and peripheral blood CTCs were detected by using negative enrichment combined with immunofluorescence.Based on the CTC detection results,the patients were divided into the CTC-positive group and the CTC-negative group.Patients in both groups were treated with neoadjuvant chemotherapy,including intravenous infusion of oxaliplatin 130 mg·m^(-2)on the first day and oral administration of capecitabine 1000 mg·m^(-2),twice a day,on days 1-14;21 days was taken as one course of treatment,and a total of 3 courses of treatment was adopted.The clinicopathological characteristics of patients in the two groups were compared.The consistency of Response Evaluation Criteria in Solid Tumors(RECIST)and evaluation criteria of CTC count was analyzed by the Kappa test.The 3-year cumulative survival rate and 5-year cumulative survival rate of patients were calculated by the Kaplan-Meier survival analysis,and the 3-year cumulative survival rate and 5-year cumulative survival rate were compared by log-rank test between the CTC-positive group and the CTC-negative group.Results Among the 112 gastric cancer patients,64 patients(57.14%)tested positive for peripheral blood CTCs,and 48 patients(42.86%)tested negative for peripheral blood CTCs.After neoadjuvant chemotherapy,the number of patients with complete remission,partial remission,stable disease and progression of disease was 0,76,21 and 15 patients,respectively;and the effective rate of treatment was 67.86%(76/112).There were statistically significant differences in the depth of tumo

关 键 词：胃癌 循环肿瘤细胞 临床病例特征 新辅助化疗 预后 

分 类 号：R735.2[医药卫生—肿瘤]