中国普外基础与临床杂志

中国普外基础与临床杂志

循环肿瘤细胞与胃癌患者临床病理特征及预后的关系研究

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目的 检测胃癌患者空腹外周静脉血中循环肿瘤细胞(CTCs)水平并探讨其与胃癌患者临床病理特征和预后的关系。 方法 选取就诊于解放军兰州总医院 2015 年 8 月至 2016 年 12 月期间经组织病理学证实为胃癌且行胃癌根治术的患者 100 例(胃癌组),选取同时期就诊于我院的胃良性病变患者 38 例作为对照(胃良性病变组)。抽取 2 组患者清晨空腹肘正中静脉血 7 mL,24 h 内采用免疫磁微粒阴性富集法联合免疫荧光原位杂交技术检测 CTCs,计算 CTCs 阳性率并分析其与胃癌患者临床病理特征(肿瘤部位、浸润深度、分化程度、TNM 分期、淋巴结转移及有无脉管癌栓)及无进展生存期的关系。 结果 胃癌组患者外周静脉血中 CTCs 阳性率为 89.0%(89/100),明显高于胃良性病变组的 10.5%(4/38),2 组间比较差异有统计学意义(P<0.001)。胃癌患者 CTCs 水平与肿瘤浸润深度(P=0.017)、淋巴结转移(P=0.038)及 TNM 分期(P=0.016)有关,而与患者性别、年龄、肿瘤部位、分化程度及有无脉管癌栓无关(P>0.050)。CTCs 对胃癌诊断的预测价值明显优于肿瘤标志物 CEA、AFP、CA19-9 和 CA125(受试者操作特征曲线下面积 0.935 比 0.711、0.570、0.666、0.551)。胃癌患者中 CTCs 低表达组术后无进展生存期明显长于高表达组(χ2=5.172,P=0.023)。 结论 免疫磁微粒阴性富集法联合免疫荧光原位杂交技术检测胃癌患者 CTCs 具有较高的敏感度和诊断价值,术前行 CTCs 检测对指导临床胃癌患者肿瘤分期及对患者预后的预测有一定的价值。

Objective To detect level of circulating tumor cells (CTCs) in peripheral venous blood of fasting patients with gastric cancer (GC) and to analyze relationships between CTCs and clinicopathologic features and prognosis of patients with GC. Methods One hundred patients with GC were selected (GC group), who underwent the surgery and confirmed by the histopathology in the Lanzhou General Hospital of PLA, from August 2015 to December 2016. Thirty-eight patients with gastric benign lesions who were treated in this hospital at the same time were selected as the control group. The 7 mL peripheral venous blood of the elbow in the morning was taken from the fasting patients and the CTCs were detected by the immunomagnetic microparticle negative enrichment combined with immunofluorescence in situ hybridization within 24 h. The positive rate of CTCs was calculated and its relationships with the clinicopathologic features (tumor location, tumor invasion depth, degree of differentiation, TNM stage, tumor markers, lymph node metastasis, and vascular tumor thrombus) and the progression-free survival of the patients with GC were analyzed. Results The positive rate of peripheral venous blood CTCs in the GC group was 89.0% (89/100), which was higher than that in the control group (10.5%, 4/38), and the difference was statistically significant (P<0.001). The levels of CTCs in the patients with GC were significantly correlated with the tumor invasion depth (P=0.017), lymph node metastasis (P=0.038), and TNM stage (P=0.016), which were not associated with the age, gender, tumor location, degree of differentiation, and vascular tumor thrombus (P>0.050). The predictive value of CTCs for the diagnosis of GC was significantly superior to that of the tumor markers CEA, AFP, CA19-9, or CA125. The progression-free survival of patients with low CTCs expression was significantly longer than that in the patients with high CTCs expression (χ2=5.172, P=0.023). Conclusions Detecting CTCs of patients with GC by immunomagnetic particle negative enrichment combined with immunofluorescence in situ hybridization has a high sensitivity. And it can improve early diagnosis of patients with GC. Preoperative CTCs detection has a certain value in guiding staging of gastric cancer and predicting prognosis of patients with GC.

关键词: 胃癌; 循环肿瘤细胞; 临床病理特征; 无进展生存期

Key words: gastric cancer; circulating tumor cells; clinicopathologic features; progression-free survival

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