循环肿瘤细胞计数在激素敏感性前列腺癌治疗中的作用研究

发布时间：2018-07-02 20:35

本文选题：循环肿瘤细胞 + 前列腺癌　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：通过检测激素敏感性前列腺癌患者外周血中的循环肿瘤细胞（circulating tumorcell，CTC）计数，结合患者临床特征、骨扫描、磁共振结果、Gleason评分、患者的血清LDH、AKP、PSA水平，分析CTC计数在激素敏感性前列腺癌患者预后评估中的意义。方法：收集苏大附一院泌尿外科2013年4月至2014年2月收治的激素敏感性前列腺癌患者，共25例，平均年龄69.2±5.0岁，平均随访周期8.4±2.43个月，收集其外周血标本，采用CellSearch细胞搜索系统对其进行CTC计数，并分别记录以上患者的临床分期、碱性磷酸酶和乳酸脱氢酶等数据。运用SPSS19.0软件包分析CTC计数与骨转移、软组织转移、原发肿瘤分期、血清LDH、AKP、PSA水平之间有无相关性，并动态检测患者治疗前、治疗后3个月、治疗后7个月的血清PSA水平，比较其与CTC计数的相关性。结果：前列腺癌患者共25例，有骨转移患者9例，CTC计数中位数5（2～23.5）个，，无骨转移的患者16例，其CTC计数中位数为1（0～2）个。经Wilcoxon检验，前列腺癌骨转移患者CTC计数与无骨转移患者CTC计数有显著差异。经Kruskal-Wallis检验，不同分期患者之间CTC计数有显著性差异（P=0.013）。进一步应用Wilcoxon法进行组间两两比较，T2与T3期患者CTC计数无显著差异（P=0.543），T3与T4期患者CTC计数差异有统计学意义（P=0.024）。将治疗7月后PSA降至0.2ng/ml以下认为患者预后较好，计算血清AKP、LDH、治疗前PSA和CTC计数的ROC曲线，CTC计数的曲线下面积最高，为0.971（P=0.000），以CTC计数为3作为临界值时，其敏感度为0.933，特异度为0.875，约登指数最大。CTC计数＜3组与CTC计数≥3组患者的治疗前PSA、治疗3月后PSA、治疗7月后PSA水平采用Mann-Whitney非参数检验，两组患者治疗前PSA水平无明显差异（P=0.183），抗雄治疗后3月、7月后PSA水平有显著差异（P=0.000）。经卡方检验，CTC≥3组的患者骨转移阳性率、肿瘤原发灶分期和Gleason评分明显高于CTC3组，其P值依次分别为P=0.009、 P=0.007、P=0.045，但软组织转移阳性率的差异（P=0.378）没有明显的统计学意义。结论：1.CTC计数与前列腺癌患者的临床特征有相关性。2.CTC计数系统对于评估前列腺癌患者的预后有作用。
[Abstract]:Objective: to detect the circulating tumorcell (CTC) count in peripheral blood of the patients with hormone sensitive prostate cancer, combined with the patient's clinical features, bone scan, MRI results, Gleason score, serum LDH, AKP, PSA level, and analyze the significance of CTC count in the evaluation of the prognosis of hormone sensitive prostate cancer patients.
Methods: 25 patients with hormone sensitive prostate cancer were collected from April 2013 to February 2014 in the Department of urology. The average age was 69.2 + 5 years old. The average follow-up period was 8.4 + 2.43 months. The peripheral blood samples were collected. The CellSearch cell search system was used to count them, and the clinical scores of the patients were recorded. SPSS19.0 software package was used to analyze the correlation between CTC count and bone metastases, soft tissue transfer, primary tumor staging, serum LDH, AKP, PSA levels, and serum PSA levels after treatment, 3 months after treatment, and 7 months after treatment, compared with CTC counts. Results: there were 25 cases of prostate cancer, 9 cases with bone metastases, and 5 cases of CTC count (2 to 23.5).
The median of CTC count was 1 (0~2) in the patients with no bone metastases. The CTC count in patients with bone metastasis of prostate cancer was significantly different from that of patients without bone metastases by Wilcoxon test. The CTC count between patients in different stages was significantly different (P= 0.013) by Kruskal-Wallis test (P= 0.013). 22 of the 22 groups were compared by Wilcoxon method, There was no significant difference in CTC count between T2 and T3 patients (P=0.543). The difference of CTC count between T3 and T4 patients was statistically significant (P=0.024). The prognosis of the patients was below 0.2ng/ml after July and the prognosis was better. As the critical value, the sensitivity was 0.933, the specificity was 0.875, the maximum.CTC count of the 3 groups and the CTC count > 3 groups of patients before the treatment PSA, the treatment of PSA after March, the PSA level after July, the two groups of patients before treatment PSA level difference (P=0.183), after the anti male treatment, March, July PSA level There were significant differences (P=0.000). After the chi square test, the positive rate of bone metastases, primary tumor staging and Gleason scores in CTC > 3 groups were significantly higher than those in group CTC3, and the P values were P=0.009, P=0.007, P=0.045, respectively, but the difference in the positive rate of soft tissue (P=0.378) was not significant. Conclusion: 1.CTC counts and prostate cancer patients. There is a correlation between the clinical characteristics of the patients and the.2.CTC counting system.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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