摘要
目的探讨循环肿瘤细胞（CTCs）在非小细胞肺癌（NSCLC）化疗疗效评价中的价值。方法选取2015年1月至2017年6月在第四军医大学第一附属医院化疗的23例NSCLC患者，分别在首次化疗前、首次化疗后3周和首次化疗后6周时抽取外周血5ml，采用CanPatrol^TM法检测CTCs；同时，在首次化疗前和首次化疗后6周时分别进行1次胸部CT检查。根据实体肿瘤疗效评价标准（RECIST）评价结果将患者分为有效组[部分缓解（PR）]和无效组[进展（PD）和稳定（SD）]。结果23例NSCLC患者首次化疗后6周时，根据RECIST进行评价，PR12例（52．2％），SD1例（4．3％），PD10例（43．5％），根据首次化疗后6周时CTCs计数变化判断，完全缓解＋PR13例（56．5％），PD10例（43．5％）；Fisher’s确切概率法检验结果表明，2种方法在疗效评价结果方面差异无统计学意义（P=1．0）；Spearman相关分析显示，首次化疗前和首次化疗后6周时CTCs计数的改变与疗效具有较好的相关性（r=0．861，P=0．000）。在有效组中，与化疗前CTCs计数[10．5（7．0，26．3）个／5ml]相比，首次化疗后3周和6周的CTCs计数均降低[（5．5（4．3，14．0）个／5ml、3．0（1．3，5．8）个／5ml]，差异有统计学意义（Z=-2．941、-3．065，P值均〈0．05）；无效组中，与化疗前CTCs计数[3．0（2．0，5．0）个／5ml]相比，首次化疗后3周和6周CTCs计数均升高[7．0（3．0，9．0）个／5ml、11．0（3．0，13．0）个／5m1]，差异有统计学意义（Z=-2．687、-2．803，P值均d0．05）。结论在NSCLC患者中，根据化疗后外周血CTCs计数的变化可早期评价疗效；CTCs检测有可能成为RECIST评价体系的一个有益补充。
Objective To investigate the value of circulating tumor cells （CTCs） in the evaluation of chemotherapeutic effect in non-small cell lung cancer （NSCLC）. Methods A total of 23 cases of patients with NSCLC receiving chemotherapy were enrolled in this study from January 2015 to June 2017 in the First Affiliated Hospital of the Fourth Military Medical University. Venous blood （5 ml） was extracted from 23 patients prior to chemotherapy, 24h before the first, second, and third cycles of chemotherapy,CTCs were anal.yzed by CanPatrol^TM. In the meantime, the tumors were monitored by computed tomography at baseline, and 6 weeks after the first cycle of chemotherapy. According to the response evaluation criteria in solid tumors （RECIST）, the patients at the time of 6 weeks after the first cycle of chemotherapy were divided into the effective group [partial response （PR）] and the ineffective group [progressive disease （PD） and stable disease （SD）]. Results The effect of chemotherapy was determined according to RECIST at the time of 6 weeks after the first cycle of chemotherapy, among the 23 patients who went under chemotherapy, the outcomes consisted of partial response in 12 cases （52.2%）, stable disease in 1 case （4.3%） and progressive disease in 10 cases （43.5%）; the effect of chemotherapy was determined according to the changes of CTCs at the time of 6 weeks after the first cycle of chemotherapy too, and the outcomes consisted of complete response and partial response in 13 cases （66.5%）, progressive disease in 10 cases （43.5%）. As the results of the Fisher＇s exact test showed, there were no significant differences between the two methods in the evaluation of curative effect （ P = 1.0）. Spearman correlation analysis showed that the changes of CTCs number at the time of 6 weeks after the first cycle of chemotherapy were correlated with the curative effect （ r =0. 861, P=0.000）. In the effective group, the number of CTCs of patients at the time of 3 weeks [5.5 （4.3,14.0）CTCs/5 ml] and 6 weeks [3.0（1.3, 5,8）CTCs/5 ml] after the first cycle of chemotherapy were lower than that of before chemotherapy [10.5 （ 7.0, 26.3 ） CTCs/5 roll, the difference was statistically significant （ Z =-2. 941, -3. 065, both P 〈0.05） ;conversely, in the ineffective group the number of CTCs of patients at the time of 3 weeks [7.0（3.0,9.0）CTCs/5 ml] and 6 weeks [11.0（3.0, 13.0）CTCs/5 roll after the first cycle of chemotherapy were higher than that of before chemotherapy [3.0 （2.0, 5.0）CTCs/5 ml], the difference was statistically significant （ Z = -2. 687, -2. 803, both P 〈0.05）. Conclusions In patients with NSCLC, the therapeutic effect can be evaluated in early stage according to the changes of CTCs number in peripheral blood after chemotherapy. CTCs detection may he a useful supplement to the evaluation system of RECIST.
作者
李发凯
陆远
王媛
吴健雄
王丽娟
薛慧君
善慧良
任新玲
Li Fakai;Lu Yuan;Wang Yuan;Wu dianxiong;Wang Lijuan;Xue Huijun;Shan Huiliang;Ren Xinling.(Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of the Fourth Military Medical University, Xi＇an 710032, China)
出处
《国际呼吸杂志》
2018年第12期898-903,共6页
International Journal of Respiration
关键词
循环肿瘤细胞
非小细胞肺癌
化疗
评价
Non-small cell lung cancer
Circulating tumor cells
Chemotherapy
Evaluation
