摘要
目的分析外周血循环肿瘤细胞(CTC)与原发性肝癌患者病理特征及术后复发的关系。方法回顾性选取2014年4月至2024年3月甘孜藏族自治州人民医院收治的肝癌患者98例(恶性组)及同期肝良性病变患者50例(良性组),比较其外周血CTC数目及类型,分析肝癌患者CTC数目与其病理参数的关系,依据术后随访1年是否复发分为复发组、未复发组,分析CTC与术后复发的相关性。采用Logistic回归分析影响肝癌患者复发的独立危险因素;绘制受试者工作特征(ROC)曲线分析CTC等预测肝癌患者复发的诊断效能。结果恶性组CTC数目、CTC阳性率高于良性组,且恶性组CTC分型间质型、混合型占比高于良性组(P<0.05);肝癌患者中,巴塞罗那临床肝癌(BCLC)C期、低分化、甲胎蛋白(AFP)>400 ng/mL、癌胚抗原(CEA)>5.0 ng/mL、糖类抗原199(CA199)>37.0 IU/mL、伴远处转移、有微血管癌栓者的CTC数目高于BCLC分期A~B期、中高分化、AFP≤400 ng/mL、CEA≤5.0 ng/mL、CA199≤37.0 IU/mL、无远处转移、无微血管癌栓患者(P<0.05);复发组入院时CTC数目及AFP、CEA、CA199水平显著高于未复发组(P<0.05);二元Logistic回归分析结果显示,CTC数目、AFP是影响肝癌患者复发的独立危险因素(OR=1.774,95%CI:1.164~2.703;OR=1.306,95%CI:1.063~1.604,均P<0.05);ROC曲线分析显示,CTC预测肝癌患者复发的曲线下面积高于AFP、CEA、CA199,但差异无统计学意义(P>0.05),其中CTC诊断肝癌患者复发的曲线下面积为0.876(95%CI:0.803~0.949),敏感度、特异度、最佳截断值分别为85.34%、78.96%、25个。结论外周血CTC与肝癌患者病理特征密切相关,CTC数目越多也提示术后有较高复发风险,监测CTC具有重要临床意义。
Objective To analyze the relationship between circulating tumor cells(CTC)in peripheral blood and the pathological features as well as postoperative recurrence in patients with primary liver cancer.Methods A total of 98 patients with liver cancer(malignant group)and 50 patients with benign hepatic lesions(benign group)who were admitted to Ganzi Tibetan Autonomous Prefecture People's Hospital from April 2014 to March 2024 were retrospectively selected.The number and types of CTC were compared.The relationship between the number of CTC and pathological parameters in liver cancer patients was analyzed.According to the presence or absence of postoperative recurrence after 1 year of follow-up,patients were divided into recurrence group and non-recurrence group.The correlation between CTC and postoperative recurrence was analyzed.Logistic regression analysis was used to identify independent risk factors influencing recurrence in liver cancer patients;receiver operating characteristic(ROC)curves were plotted to analyze the diagnostic efficacy of CTC and other factors in predicting recurrence of liver cancer patients.Results The number of CTC and the CTC positive rate in the malignant group were higher than that in the benign group,and the proportions of mesenchymal and hybrid CTC subtypes in the malignant group were higher than those in the benign group(P<0.05).Among liver cancer patients,the number of CTC was higher in patients with Barcelona Clinic Liver Cancer(BCLC)stage C,poor differentiation,alpha fetoprotein(AFP)>400 ng/mL,carcinoembryonic antigen(CEA)>5.0 ng/mL,carbohydrate antigen 199(CA199)>37.0 IU/mL,distant metastasis,or microvascular cancer thrombus than in patients with BCLC stage A-B,moderate/high differentiation,AFP≤400 ng/mL,CEA≤5.0 ng/mL,CA199≤37.0 IU/mL,no distant metastasis,or no microvascular cancer thrombus(P<0.05).At admission,the number of CTC and levels of AFP,CEA,and CA199 in the recurrence group were significantly higher than those in the non-recurrence group(P<0.05).Binary logistic regression analysis showed that the number of CTC and AFP were independent risk factors for recurrence in liver cancer patients(OR=1.774,95%CI:1.164-2.703;OR=1.306,95%CI:1.063-1.604,P<0.05).ROC curve analysis showed that the area under the curve(AUC)of CTC for predicting recurrence in liver cancer patients was higher than that of AFP,CEA,or CA199,but the difference was not statistically significant(P>0.05).The AUC of CTC for diagnosing recurrence in liver cancer patients was 0.876(95%CI:0.803-0.949),with a sensitivity of 85.34%,specificity of 78.96%,and optimal cutoff value of 25.Conclusion CTC in peripheral blood are closely related to pathological features in liver cancer patients.A higher number of CTC also indicates a greater risk of postoperative recurrence.Monitoring CTC is of significant clinical importance.
作者
李治宏
谢德坤
谢贵龙
陈颖
张奎
何雨
LI Zhihong;XIE Dekun;XIE Guilong;CHEN Ying;ZHANG Kui;HE Yu(Department of Hepatobiliary,Ganzi Tibetan Autonomous Prefecture People's Hospital,Ganzi,Sichuan 626001,China;Department of Anesthesiology,Sichuan Provincial People's Hospital,Chengdu,Sichuan 610000,China)
出处
《转化医学杂志》
2025年第8期76-80,共5页
Translational Medicine Journal
基金
四川省科技计划项目(2019YFS0529)。
关键词
外周血循环肿瘤细胞
肝癌
病理特征
复发
相关性
circulating tumor cell in peripheral blood
liver cancer
pathological feature
recurrence
correlation
