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循环肿瘤细胞在食管癌根治性放疗中的临床意义

Clinical significance of circulating tumor cells in radical radiotherapy for esophageal cancer

    摘要
  • 摘要:
    目的 探讨食管癌患者循环肿瘤细胞(CTCs)与临床特征及预后的相关性。
    方法 选取南通市通州区人民医院2019年8月11日—2021年3月4日收治的114例食管鳞癌患者为研究对象，采用免疫磁珠阴性富集联合免疫荧光原位杂交技术检测CTCs。收集患者临床资料，结合其TNM分期、性别、年龄、肿瘤位置等临床特征进行统计学分析; 比较50例根治性放疗患者在放疗前后的CTCs水平，分析CTCs水平与近期缓解率和无进展生存期(PFS)的关系。
    结果 114例食管鳞癌患者CTCs阳性率与年龄、性别、肿瘤位置无相关性(P＞0.05), 与肿瘤T分期、N分期、M分期以及临床分期有相关性(P＜0.05或P＜0.01)。50例患者放疗前的CTCs阳性率为62.00%(31/50), 放疗后的CTCs阳性率为52.00%(26/50), 差异无统计学意义(χ2=1.020, P=0.313)。Kaplan-Meier方法绘制生存曲线的结果显示，放疗前CTCs阴性患者PFS为18.62个月(95%CI: 15.24~21.99), 高于CTCs阳性患者的13.84个月(95%CI: 10.01~17.68), 差异有统计学意义(P=0.048)。放疗后CTCs阴性患者PFS为19.58个月(95%CI: 16.51~22.67), 高于CTCs阳性患者的12.13个月(95%CI: 7.94~16.32), 差异有统计学意义(P=0.003)。多因素Cox回归分析显示，肿瘤临床分期、放疗后CTCs是食管鳞癌患者的独立预后因子(P＜0.05)。
    结论 CTCs是食管鳞癌患者病情进展评估及放疗后预后评价的重要指标。

     

    Abstract:
    Objective To explore the correlations of circulating tumor cells (CTCs) with clinical features and prognosis in patients with esophageal cancer.
    Methods A total of 114 patients with esophageal squamous cell carcinoma in Tongzhou District People's Hospital of Nantong City from August 11, 2019 to March 4, 2021 were selected as research objects, and CTCs were detected by immunomagnetic bead negative enrichment combined with immunofluorescence in situ hybridization. The clinical data of patients were collected and statistically analyzed in combination with clinical features such as TNM staging, gender, age and tumor location; the level of CTCs before and after radiotherapy was compared in 50 patients with radical radiotherapy, and the correlations of CTCs level with short-term remission rate and progression free survival (PFS) were analyzed.
    Results In 114 patients with esophageal squamous cell carcinoma, positive rate of CTCs had no correlations with age, gender and tumor location (P > 0.05), but was correlated with T staging, N staging, M staging and clinical stages (P < 0.05 or P < 0.01). The positive rate of CTCs in 50 patients was 62.00% (31/50) before radiotherapy and 52.00% (26/50) after radiotherapy, and there was no significant difference before and after radiotherapy (χ2=1.020, P=0.313). The survival curve drawn by Kaplan-Meier method showed that the PFS of patients negative for CTCs before radiotherapywas 18.62 months (95%CI, 15.24 to 21.99), which was significantly higher than 13.84 months (95%CI, 10.01 to 17.68) of patients positive for CTCs before radiotherapy(P=0.048). After radiotherapy, the PFS of patients negative for CTCs was 19.58 months (95%CI, 16.51 to 22.67), which was significantly higher than 12.13 months (95%CI, 7.94 to 16.32) of patients positive for CTCs (P=0.003). Multivariate Cox regression analysis showed that tumor clinical stages and CTCs after radiotherapy were the independent prognostic factors of patients with esophageal squamous cell carcinoma (P < 0.05).
    Conclusion CTCs i s an important index in evaluating the progress of disease and prognostic assessment after radiotherapyin patients with esophageal squamous cell carcinoma.

     

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