循环肿瘤细胞与循环肿瘤血管内皮细胞在乳腺癌新辅助化疗疗效评估中的临床意义  

Clinical significance of circulating tumor cells and circulating tumor vascular endothelial cells in the eval-uation of the efficacy of neoadjuvant chemotherapy for breast cance

作　　者：李怡康 仝伟兵 Li Yikang;Tong Weibing(Graduate School,Inner Mongolia Medical University,Hohhot,Inner Mongolia010110,China;Department of Breast Surgery,Peking University Cancer Hospital Inner Mongolia Hospital,Cancer Hospital Affiliated to Inner Mongolia Medical University,Hohhot,Inner Mongolia 010110,China)

机构地区：[1]内蒙古医科大学研究生学院,内蒙古自治区呼和浩特010110 [2]北京大学肿瘤医院,内蒙古医院内蒙古医科大学附属肿瘤医院乳腺外科,内蒙古自治区呼和浩特010110

出　　处：《中国药物与临床》2024年第23期1527-1531,共5页Chinese Remedies & Clinics

摘　　要：目的通过瘤标免疫荧光染色-染色体原位杂交(SE-iFISH)法分别在新辅助化疗前后对乳腺癌患者进行外周血循环肿瘤细胞(CTC)和循环肿瘤血管内皮细胞(CTEC)检测,观察CTC和CTEC数目的变化特点,并评估其预测新辅助化疗疗效的潜在价值。方法根据纳入标准与排除标准,选取2021年12月至2022年12月就诊于内蒙古医科大学附属肿瘤医院需进行新辅助化疗的乳腺癌确诊患者外周血5 ml,用SE-iFISH法检测CTC和CTEC。判读时,将CTC数目≥3个定义为CTC阳性,将CTEC数目≥1个定义为CTEC阳性。结果CTC检测数目由新辅助化疗前M(P_(25),P_(75))=3(2,5)降为新辅助化疗后M(P_(25),P_(75))=1(0.25,1.75);CTEC检测数目由新辅助化疗前M(P_(25),P_(75))=3(1,3)降为新辅助化疗后M(P_(25),P_(75))=0(0,0)。在所纳入的40例患者中,根据病理学Miller-Payne标准(金标准),新辅助化疗评估为有效的患者18例,而评估为无效的患者22例。以新辅助化疗前后CTC的变化为评估标准,评估为有效的患者24例,评估为无效的16例。与金标准相比,其敏感度为77.8%,特异度为54.6%,McNemar检验显示这2种方法差异无统计学意义(P=0.180),且存在低等相符(K_(appa)=0.314,P<0.05)。以新辅助化疗前后CTEC的变化为评估标准,评估为有效的患者35例,评估为无效的患者5例,CTEC检测敏感度为94.4%,特异度为18.2%。McNemar检验显示这2种方法在评估疗效时差异有统计学意义(P<0.001),且评价一致性较弱(K_(appa)=0.116,P>0.05)。结论新辅助化疗前后CTC和CTEC数目的变化与新辅助化疗的疗效分别具有相关性。CTC的变化一定程度上可以反映新辅助化疗的疗效,可能成为新辅助化疗疗效评估的预测指标;CTEC的变化对新辅助化疗疗效的预测作用还有待研究进一步证实。Objective To evaluate the potential clinical value of detecting the number of circulating tumor cells(CTC)and circulating tumor endothelial cells(CTEC)using SE-iFISH method before and after neoadjuvant chemotherapy in patients with breast cancer.Methods According to the inclusion and exclusion criteria,periph-eral blood samples(5 ml)were collected from breast cancer patients who were scheduled to undergo neoadjuvant chemotherapy at Cancer Hospital Affiliated to Inner Mongolia Medical University from December 2021 to Decem-ber 2022.CTCs and CTECs were detected using the SE-iFISH method.CTC positivity was defined as the presence of≥3 CTCs,while CTEC positivity was defined as the presence of≥1 CTEC.Results The median CTC count decreased from M(P_(25),P_(75))=3(2,5)before neoadjuvant chemotherapy to M(P_(25),P_(75))=1(0.25,1.75)after neoadju-vant chemotherapy.The median CTEC count decreased from M(P_(25),P_(75))=3(1,3)before neoadjuvant chemothera-py to M(P_(25),P_(75))=0(0,0)after neoadjuvant chemotherapy.Among the 40 enrolled patients,18 patients were as-sessed as effective and 22 patients were assessed as ineffective based on the Miller-Payne pathological criteria(gold standard)for neoadjuvant chemotherapy evaluation.Using the change in the number of CTCs as the evalua-tion criterion,24 patients were assessed as effective and 16 patients were assessed as ineffective.Compared to the gold standard,the sensitivity of CTC evaluation was 77.8%,and the specificity was 54.6%,with McNemar test showing no statistical difference between the two methods(P=0.180),and there was fair agreement(K_(appa)=0.314,P<0.05). Using the change in the number of CTECs as the evaluation criterion, 35 patients were assessed as effec-tive and 5 patients were assessed as ineffective. The sensitivity of CTEC detection was 94.4%, and specificity was 18.2%. McNemar test showed a significant statistical difference between the two methods for evaluating efficacy (P<0.001), and there was weak agreement (K_(appa)=0.116, P>0.05). Conclusion The ch

关 键 词：乳腺肿瘤 放化疗 肿瘤细胞 循环 治疗效果 

分 类 号：R737.9[医药卫生—肿瘤]