结直肠癌循环肿瘤细胞计数的临床意义

发布时间：2018-03-26 01:16

本文选题：结直肠肿瘤　切入点：肿瘤细胞　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:通过对结直肠癌患者循环肿瘤细胞(CTC)的检测,评价其在分期、评估疗效、监测复发转移及诊断中的价值。方法:(1)采集符合纳入标准的初治结直肠癌患者及健康对照外周血7.5ml,用包被有抗上皮细胞黏附分子(Epithelial cell adhesion molecule,EpCAM)抗体的磁珠对CTC进行富集,对细胞角蛋白阳性(CK+),核染阳性(DAPI+),白细胞共同抗原阴性(CD45-)的CTC进行计数,分析结直肠癌患者治疗前CTC阳性率与临床病理特征的关系,评估其在分期中的价值;(2)同时对上述患者中接受手术的41例患者于术后7天进行CTC检测,分析手术前后CTC阳性率的差异,评价CTC评估疗效的价值;(3)另选取一组既往于我院行结直肠癌手术且一个月内未行任何治疗的复查患者82例进行CTC检测,分析复发转移患者与非复发转移患者CTC阳性率的差异,评价其检测复发转移的价值;(4)另本研究还对34例结直肠良性肿瘤患者进行CTC检,评价其诊断价值。结果:(1)结直肠癌患者外周血中CTC的阳性率与患者的N分期及M分期显著相关(N0、N1、N2期CTC阳性率分别为38.3%、37.9%、63.9%;M1、M2期CTC阳性率分别为38.0%、71.1%),差异有统计学意义(N分期:χ~2=6.819,P=0.033;M分期:χ~2=12.074,P=0.001);而与性别、年龄、原发灶部位、T分期、血小板、脉管癌栓、自然杀伤细胞、调节性T细胞未见显著差异(P0.05)。(2)McNemar统计结果显示:手术前后患者CTC阳性率未见显著差异(P=0.581)。(3)常规复查的术后结直肠癌患者中非复发转移者与复发转移者CTC阳性率分别为51.6%、90.0%,差异有统计学意义(χ~2=9.365,P=0.002)。(4)结直肠癌患者、结直肠良性肿瘤患者及健康对照CTC阳性率分别为47.12%、35.3%、0%,差异有统计学意义(χ~2=25.931,P0.001);两两比较显示结直肠癌患者与结直肠良性肿瘤患者CTC阳性率未见明显差异(χ~2=1.538,P=0.215),结直肠癌患者与健康对照、结直肠良性肿瘤与健康对照CTC阳性率差异均有统计学意义(分别为χ~2=25.743,P0.001;χ~2=14.571,P0.001)。结论:治疗前CTC检测可用于评估结直肠癌患者转移的发生;而术后7天进行CTC的检测尚不能用于手术疗效的评估;常规复查的术后1个月内未行治疗的术后结直肠癌患者CTC检测可用于监测结直肠癌患者的复发转移;CTC尚不能用于良恶性肿瘤的鉴别,但对结直肠肿瘤有重要的预警作用,提示患者应该定期随访观察。
[Abstract]:Objective: to evaluate the stage and efficacy of circulating tumor cell CTC in patients with colorectal cancer. Methods to collect 7.5 ml peripheral blood of primary colorectal cancer patients and healthy controls, and to enrich CTC with magnetic beads coated with anti-epithelial cell adhesion molecule EpCAMantibody. The CTC of cytokeratin-positive CK, nuclear staining and leukocyte common antigen negative CD45-were counted, and the relationship between the positive rate of CTC and clinicopathological features of colorectal cancer patients before treatment was analyzed. At the same time, 41 patients who underwent operation were examined for CTC on the 7th day after operation, and the difference of CTC positive rate before and after operation was analyzed. To evaluate the value of CTC in evaluating the curative effect, another group of 82 patients who had undergone colorectal cancer surgery in our hospital and had not received any treatment within one month were examined for CTC. The difference of CTC positive rate between patients with recurrent metastasis and those with non-recurrence and metastasis was analyzed. In addition, 34 patients with colorectal benign tumors were examined by CTC. Results the positive rate of CTC in peripheral blood of patients with colorectal cancer was significantly correlated with the N stage and M stage of colorectal cancer. The positive rates of CTC in N0 / N1 / N2 phase were 38.3% and 37.3% respectively. The positive rates of CTC in M1M 2 phase were 38.0% and 71.1%, respectively. Stage: 蠂 ~ 2 / 6.819 / P ~ (0.033) M: 蠂 ~ (2 / 2) 12.074 / P ~ (0.001); Age, T stage of primary site, platelets, vascular tumor thrombus, natural killer cells, There was no significant difference in regulatory T cells. The statistical results showed that there was no significant difference in the positive rate of CTC before and after operation. (P < 0.05) the positive rates of CTC in patients with non-recurrence and metastasis after operation were respectively higher than those in patients with recurrent and metastatic colorectal cancer. The difference was statistically significant in patients with colorectal cancer (蠂 ~ 2, P = 9.365, P = 0.002, P = 0.002, P < 0.05). The positive rates of CTC in patients with colorectal benign tumors and healthy controls were 47.12 and 35.30.The difference was statistically significant (蠂 ~ 2 ~ 2 ~ (25. 931) ~ (1) P ~ (0.001)), and there was no significant difference in the positive rates of CTC between colorectal cancer patients and benign colorectal cancer patients (蠂 ~ (21) 1.538 P ~ (0.215)), colorectal cancer patients and healthy controls (蠂 ~ (21) 1.538 P ~ (0.215), P < 0.05), the positive rate of CTC in colorectal cancer patients was significantly higher than that in healthy controls (P < 0.05). There were significant differences in CTC positive rates between colorectal benign tumors and healthy controls (蠂 ~ (2) P = 25.743, P 0.001, 蠂 ~ (2) = 14.571) P 0.001.Conclusion: before treatment, CTC detection can be used to evaluate the occurrence of metastasis in patients with colorectal cancer. However, 7 days after operation, the detection of CTC could not be used to evaluate the curative effect of the operation. CTC detection in postoperative colorectal cancer patients who were not treated within 1 month by routine reexamination can be used to monitor the recurrence and metastasis of colorectal cancer patients. CTCs can not be used in the differential diagnosis of benign and malignant tumors, but it plays an important role in the early warning of colorectal cancer. It suggests that patients should be followed up regularly.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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