循环肿瘤细胞在中晚期非小细胞肺癌化疗疗效监测及预后判断中的初步探讨

发布时间：2017-12-27 15:43

本文关键词：循环肿瘤细胞在中晚期非小细胞肺癌化疗疗效监测及预后判断中的初步探讨　出处：《南华大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过动态监测中晚期非小细胞肺癌患者化疗前、2周期化疗后及影像学评估进展时CTCs的水平。侧重探讨CTCs与近期疗效及患者预后的相关性,进一步探讨其临床应用价值;并分析多因素对患者预后的影响,明确CTCs能否作为判别患者预后的独立因素。方法:采用Cellsearch系统检测了118例晚中期非小细胞肺癌患者化疗前CTCs水平,有效病例数107例;其中有78例患者在2周期化疗后进行了影像学评估,同时抽血行CTCs检测;78例患者中,有42例随访过程中出现PD,并在PD时再次抽血行CTCs检测。关于非小细胞肺癌CTCs阳性标准,目前尚无最佳临界值(cut-off)界定,本研究把cut-off值确定为1个,即只要在7.5ml外周血中发现CTCs则为阳性。结果:1.CTCs患者PFS的相关性:107例患者均在化疗前行CTCs检测,CTCs阳性率为39.3%;阳性患者中位PFS为4.3月,阴性患者为7.3月,数据有统计学差异(P=0.002);其中有78例患者在2周期化疗后行CTCs检测,阳性组中位PFS为2.5月,阴性者为5.8月,两组差别有统计学意义(P=0.002);化疗前后CTCs变化水平与患者中位PFS无统计学意义。2.CTCs与患者远期生存的相关性:化疗前CTCs阳性患者1年生存率为35.7%,阴性患者为60.0%,差异有统计学意义(P=0.014);2周期化疗后ctcs阳性患者1年生存率为30.0%,阴性患者为56.8%,差异有统计学差异(p=0.038);化疗前后ctcs变化及疾病进展时ctcs水平与1年生存率差异无统计学意义。3.化疗前后ctcs变化与影像学评估的相关性:78例患者在化疗前及2周期化疗后行影像学评估,并抽血行ctcs检测,化疗前ctcs阳性率41.0%,化疗后阳性率25.6%,化疗前后ctcs变化具有统计学差异。按照recist评价标准,有25例患者获得pr,37例患者为sd,16例患者评价为pd,无cr患者。化疗前后ctcs上升17例,下降21例,无变化40例。数据统计表明,在近期疗效评价中,ctcs变化水平与影像学评价具有很高的一致性。以ctcs阳性率分层显示,影像学评价显示pd的患者,ctcs阳性率高达68.8%,而影像学评价sd的患者,ctcs阳性率18.4%,影像学评价为pr的患者,其ctcs阳性率仅为8.2%,且数据具有统计学差异(p0.05)。4.疾病进展时ctcs水平与局部复发、远处复发的关系:在42例pd患者中,ctcs阳性患者28例,其中远处转移复发比率为71.4%,ctcs阴性患者14例,远处转移复发比率为35.7%,数据有统计学差异(p=0.026)。5.患者tnm分期与pfs相关,患者年龄及吸烟史均与1年生存率相关。结论:1.化疗前、2周期化疗后循环肿瘤细胞水平是pfs的预测因素;2.化疗前循环肿瘤细胞水平是患者1年生存期的预测因素;3.化疗前后CTCs变化与影像学化疗疗效评估具有一致性。
[Abstract]:Objective: to dynamically monitor the level of CTCs in patients with advanced non-small cell lung cancer (non-small cell lung cancer) before and after chemotherapy and imaging evaluation of advanced non-small cell lung cancer (non-small cell lung cancer). We focused on the relationship between CTCs and short-term prognosis and prognosis, and further explored its clinical application value. We also analyzed the influence of multiple factors on the prognosis of patients, and determined whether CTCs could be used as an independent prognostic factor. Methods: the Cellsearch was detected in 118 cases of late stage non-small cell lung cancer patients before chemotherapy CTCs level, effective 107 cases; there were 78 patients in the 2 cycle of chemotherapy after the imaging assessment and blood CTCs detection; 78 cases of patients, 42 cases were followed up after PD process. And in the PD again when the blood for CTCs detection. There is no optimal threshold value (cut-off) for the CTCs positive standard of non-small cell lung cancer. In this study, the cut-off value is identified as 1, that is, as long as CTCs is found in peripheral blood of 7.5ml, it is positive. Results: the correlation between 1.CTCs PFS patients: 107 cases of patients before chemotherapy in CTCs detection, the positive rate of CTCs was 39.3%; in patients with positive PFS negative patients was 4.3 months, 7.3 months, the data have significant difference (P=0.002); there were 78 patients in the 2 cycle of chemotherapy were tested by CTCs, in a positive group PFS for 2.5 months, the negative of 5.8 months, there was a significant difference between the two groups (P=0.002); CTCs level and patients with a PFS had no statistical significance before and after chemotherapy. The correlation between 2.CTCs and long-term survival of the patients before chemotherapy in CTCs positive patients 1 year survival rate was 35.7%, negative patients was 60%, the difference was statistically significant (P=0.014); after 2 cycles of chemotherapy in CTCs positive patients 1 year survival rate was 30%, negative patients was 56.8%, the difference had statistical difference was not statistically significant (p=0.038); before and after chemotherapy and disease progression of CTCS changes in CTCS Level and 1 year survival rate difference. 3., the correlation between CTCs and imaging evaluation before and after chemotherapy: 78 patients underwent imaging evaluation before chemotherapy and 2 cycles of chemotherapy, and blood samples were taken for CTCs detection. The positive rate of CTCS before chemotherapy was 41%, and the positive rate after chemotherapy was 25.6%. There was statistical difference in CTCs before and after chemotherapy. According to the RECIST evaluation criteria, 25 patients received PR, 37 patients were SD, 16 patients were evaluated as PD, and no CR patients. Before and after chemotherapy, CTCs increased in 17 cases, decreased in 21 cases, and no change in 40 cases. Data statistics show that in the recent evaluation of curative effect, the level of CTCS changes is very consistent with the evaluation of imaging. The positive rate of CTCS was stratified. Imaging evaluation showed that the positive rate of CTCS in PD patients was as high as 68.8%, while the CTCs positive rate was 18.4% in patients with SD imaging. The positive rate of CTCS in radiographic evaluation of PR was only 8.2%, and the data had statistical difference (P0.05). 4., the relationship between CTCS Level and local recurrence and distant recurrence in disease progression: in 42 PD patients, 28 cases of CTCS positive patients, including distant metastasis recurrence rate 71.4%, CTCs negative patients 14 cases, distant metastasis recurrence rate 35.7%, and the data were statistically different (p=0.026). 5. patients with TNM staging were associated with PFS, and the age and smoking history of the patients were related to the 1 year survival rate. Conclusion: 1.. The level of circulating tumor cells before and after 2 cycles of chemotherapy is a predictor of PFS. 2., the level of circulating tumor cells before chemotherapy is the predictor of 1 year survival of patients. 3., the CTCs change before and after chemotherapy is consistent with imaging chemotherapy efficacy evaluation.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

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