摘要
目的循环肿瘤细胞(circulating tumor cells,CTCs)被认为是肿瘤复发转移的重要因素之一,食管鳞癌患者放疗后CTCs阳性率较治疗前下降并和预后相关。本研究探讨进展期食管鳞癌新辅助化疗中CTCs的状态,以及CTCs与食管癌临床特征及预后的相关性。方法回顾性分析十堰市太和医院(湖北医药学院附属医院)2013-01-10-2014-03-27收治的96例食管鳞癌患者,采用免疫磁珠富集联合免疫荧光法检测患者外周血中CTCs,对比分析患者CTCs状态与临床特征及2年生存率的关系。同时分析患者新辅助放化疗前后CTCs状态的变化,以期明确新辅助治疗的意义及适应人群。计数资料采用χ~2检验或Fisher精确概率法,生存分析采用Kaplan-Meier法和Cox模型法。结果 96例患者随访至2016-03-27,随访率100%,中位随访时间25个月。患者CTCs状态与肿瘤的病变长度、T分期、N分期及临床分期相关(P<0.05),与患者的年龄、性别及病变部位无关,P>0.05。首诊CTCs阳性患者的中位生存时间约19.2个月;而CTCs阴性患者的中位生存时间约26.8个月,两者差异有统计学意义,P=0.038。Cox模型结果显示,Ⅲ~ⅣA期是影响CTCs不同状态患者的独立危险因素。首诊CTCs阳性的患者Ⅱ期中位生存时间为28.2个月,与CTCs阴性患者的30.2个月比较,差异无统计学意义,P=0.189;但Ⅲ期的中位生存时间分别为19.9和24.6个月,差异有统计学意义,P=0.044;ⅣA期的中位生存时间分别为11.2和21.2个月,差异有统计学意义,P=0.045。新辅助治疗后,有21例(34.42%)患者由CTCs阳性转为阴性,转阴率差异有统计学意义,P=0.002。新辅助治疗后,CTCs仍为阳性的患者中位生存时间约16.5个月,与CTCs转阴的患者(23.4个月)和首诊CTCs阴性的患者(26.8个月)比较,差异有统计学意义,P<0.05;但后两者差异无统计学意义,P>0.05。结论 CTCs可反映食管癌患者的疾病进展程度,并可作为判断预后的指标。此外,新辅助放化疗可改善首诊CTCs阳性患者的中位生存时间。
OBJECTIVE Circulating tumor cells are considered to be the main factor of recurrence of tumor.There were reports showed that the CTCs positive percentage of esophageal cancer were decreased after the radiation,which was closely related to the prognosis of esophageal cancer.This study was designed to evaluate the changes of circulating tumor cells in locally advanced esophageal squamous cell carcinoma patients treated with neoadjuvant therapy.The dynamic changes of circulating tumor cells during neoadjuvant were also analyzed.METHODS Between Jan 2013 and Mar 2014,96 cases with histologically diagnosed esophageal squamous carcinoma were enrolled.Circulating tumor cells were detected by immunomagnatec enrichment and fluorescence in these patients.The dynamic changes of CTCs were compared between pre-and post-neoadjuvant therapy.the association of these changes with the clinical characteristics and two-year survival rate were analyzed.The different CTCs status among esophageal cancer patients were compared withχ~2 test and survival analysis was performed by Kaplan-Meier methods and Cox model.RESULTS To March 27 th in 2014,the follow-up rate was 100%.The positive rate of CTCs was closely related with the length of lesion,T stage,N stage and clinical stage（P〉0.05）,and it was not likely to be associated with age,sex and lesion location（P0.05）.The median survival of CTCs positive group was 19.2 months,and it was 26.8 months in CTCs negative group.Multivariate analysis revealed that the clinical stage was the prognostic influencing factor.The median survival time of stageⅢ patients were19.9months and 24.6months respectively.The difference had statistical significance（P=0.044）.The median survival time of stageⅣ patients were 11.2months and 21.2months respectively,and it also showed statistical significance（P=0.045）.There was no significant difference in clinical stageⅡ between two groups（P=0.189）.After neoadjuvant therapy,there were 21 cases showed CTCs negative and they were switched from CTCs positive status,and this change was statistically significant（P0.05）.After neoadjuvant therapy,the CTCs status remain positive showed quite poor survival（16.5months）,which was significant inferior to CTCs change group and CTCs negative group（23.4mon and 26.8mon,respectively）.There was no statistically difference between CTCs change group and CTCs negative group.CONCLUSIONS Circulating tumor cells could reflect the disease progression in patients with locally advanced esophageal squamous cell carcinoma,and it may be a quite good prognostic factor.In addition,it seems that the neoadjuvant therapy was beneficial to the median survival of CTCs positive esophageal patients.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2017年第8期561-565,共5页
Chinese Journal of Cancer Prevention and Treatment
关键词
食管鳞癌
CTCS
新辅助治疗
放化疗
疗效
预后
esophageal squamous cell carcinoma
circulating tumor cells
neoadjuvant therapy
chemoradiatherapy
outcome
prognostic value
