动态监测循环肿瘤细胞在肝癌患者术后随访中的作用  

Role of dynamic monitoring of circulating tumor cells in postoperative follow-up of patients with hepatocel-lular carcinoma

作　　者：周鑫[1] 张涵 徐静[1] ZHOU Xin;ZHANG Han;XU Jing(Department of Oncology,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院肿瘤科,南京210029

出　　处：《医学研究与战创伤救治》2025年第3期273-277,共5页Journal of Medical Research & Combat Trauma Care

摘　　要：目的评估动态监测循环肿瘤细胞(CTC)在肝癌患者术后随访中的预后价值。方法选取2019年1月至2020年11月在江苏省人民医院肿瘤科就诊的确诊为肝癌并接受根治性手术治疗的24例患者的临床资料。对所有患者术前及术后根据患者真实世界实际情况进行CTC检测。将CTC相关指标归纳为:CTC检测次数、是否检测到CTM、检测到CTM次数、第一次CTC数目、最高CTC数目、有无CTC连续两次检测倍增、有无CTC连续三次检测递减,以及有无CTC连续两次检测减半事件。利用Kaplan-Meier法及单因素、多因素COX比例风险回归模型评估CTC相关指标及其他变量对无复发生存期(RFS)和总生存期(OS)的影响。结果Kaplan-Meier曲线分析显示,术前AFP水平、不同TNM分期以及随访期间连续两次CTC检测出现倍增事件可显著影响肝癌患者的临床预后(P<0.05)。单因素分析显示,AFP、CTC连续两次检测倍增是肝癌患者无复发生存期的影响因素(P<0.05),AFP、TNM分期是肝癌患者总体生存期的影响因素(P<0.05)。多因素分析显示AFP是无复发生存期、总体生存期的独立预测因素(P=0.007、0.012)。结论CTC动态监测可以作为肝癌术后复发风险预测的有力工具,有助于个体化治疗方案的制定。Objective To evaluate the predictive value of dynamic monitoring of circulating tumor cell(CTC)in the postop-erative follow-up of patients with hepatocellular carcinoma(HCC).Methods A total of 24 HCC patients who received radical sur-gery at Jiangsu Provincial People′s Hospital from January 2019 to November 2020 were selected.CTC detection was performed before and after the surgery according to real-world conditions of the patients.The CTC-related indicators were summarized as follows:the number of CTC tests,whether circulating tumor microemboli(CTM)were detected,the times of positive CTM tests,the number of CTC in the first test,the highest number of CTC,whether there was a doubling of CTC in two consecutive tests,whether there was a decrease in CTC in three consecutive tests,and whether there was a halving of CTC in two consecutive tests.The Kaplan-Meier method and univariate and multivariate COX proportional hazards regression models were used to evaluate the impact of CTC-related indicators and other variables on recurrence-free survival(RFS)and overall survival(OS).Results The Kaplan-Meier curve analysis showed that preoperative AFP levels,different TNM stages,and a doubling event in CTC in two consecutive tests during follow-up could signif-icantly affect the clinical prognosis of HCC patients(P<0.05).Univariate analysis showed that AFP and a doubling event in two con-secutive CTC tests were the influencing factors for RFS in HCC patients(P<0.05),while AFP and TNM stage were the influencing factors for OS in HCC patients(P<0.05).Multivariate analysis showed that AFP was an independent predictor for both RFS and OS(P=0.007 and 0.012,respectively).Conclusion Dynamic monitoring of CTC can be a powerful tool for predicting the risk of recurrence after HCC surgery and is helpful for the development of in-dividualized treatment plans.

关 键 词：循环肿瘤细胞 肝癌 动态监测 预后 

分 类 号：R735.7[医药卫生—肿瘤]