食管鳞癌循环肿瘤细胞在新辅助放化疗中动态变化及预后意义

发布时间：2018-05-03 18:13

  本文选题：食管鳞癌 + CTCs　； 参考：《中华肿瘤防治杂志》2017年08期

【摘要】：目的循环肿瘤细胞(circulating tumor cells,CTCs)被认为是肿瘤复发转移的重要因素之一,食管鳞癌患者放疗后CTCs阳性率较治疗前下降并和预后相关。本研究探讨进展期食管鳞癌新辅助化疗中CTCs的状态,以及CTCs与食管癌临床特征及预后的相关性。方法回顾性分析十堰市太和医院(湖北医药学院附属医院)2013-01-10-2014-03-27收治的96例食管鳞癌患者,采用免疫磁珠富集联合免疫荧光法检测患者外周血中CTCs,对比分析患者CTCs状态与临床特征及2年生存率的关系。同时分析患者新辅助放化疗前后CTCs状态的变化,以期明确新辅助治疗的意义及适应人群。计数资料采用χ~2检验或Fisher精确概率法,生存分析采用Kaplan-Meier法和Cox模型法。结果 96例患者随访至2016-03-27,随访率100%,中位随访时间25个月。患者CTCs状态与肿瘤的病变长度、T分期、N分期及临床分期相关(P0.05),与患者的年龄、性别及病变部位无关,P0.05。首诊CTCs阳性患者的中位生存时间约19.2个月;而CTCs阴性患者的中位生存时间约26.8个月,两者差异有统计学意义,P=0.038。Cox模型结果显示,Ⅲ~ⅣA期是影响CTCs不同状态患者的独立危险因素。首诊CTCs阳性的患者Ⅱ期中位生存时间为28.2个月,与CTCs阴性患者的30.2个月比较,差异无统计学意义,P=0.189;但Ⅲ期的中位生存时间分别为19.9和24.6个月,差异有统计学意义,P=0.044;ⅣA期的中位生存时间分别为11.2和21.2个月,差异有统计学意义,P=0.045。新辅助治疗后,有21例(34.42%)患者由CTCs阳性转为阴性,转阴率差异有统计学意义,P=0.002。新辅助治疗后,CTCs仍为阳性的患者中位生存时间约16.5个月,与CTCs转阴的患者(23.4个月)和首诊CTCs阴性的患者(26.8个月)比较,差异有统计学意义,P0.05;但后两者差异无统计学意义,P0.05。结论 CTCs可反映食管癌患者的疾病进展程度,并可作为判断预后的指标。此外,新辅助放化疗可改善首诊CTCs阳性患者的中位生存时间。
[Abstract]:Objective circulating tumor cells were considered to be one of the important factors of tumor recurrence and metastasis. The positive rate of CTCs in patients with esophageal squamous cell carcinoma after radiotherapy was lower than that before radiotherapy and was related to prognosis. This study was to investigate the status of CTCs in neoadjuvant chemotherapy for advanced esophageal squamous cell carcinoma and the correlation between CTCs and clinical features and prognosis of esophageal carcinoma. Methods 96 patients with esophageal squamous cell carcinoma treated in Taihe Hospital of Shiyan City (affiliated Hospital of Hubei Medical College) were retrospectively analyzed. CTCs in peripheral blood of patients were detected by immunomagnetic bead enrichment combined with immunofluorescence. The relationship between CTCs status and clinical features and 2 year survival rate was compared and analyzed. The changes of CTCs status before and after neoadjuvant radiotherapy and chemotherapy were analyzed in order to determine the significance of neoadjuvant therapy and adapt to population. The count data were analyzed by 蠂 ~ 2 test or Fisher exact probability method, and survival analysis by Kaplan-Meier method and Cox model method. Results 96 patients were followed up to 2016-03-27, the follow-up rate was 100 and the median follow-up time was 25 months. The CTCs status was correlated with the length of the tumor, T stage and clinical stage (P 0.05), but not with the age, sex and location of the tumor. The median survival time of first diagnosed CTCs positive patients was 19.2 months, while that of CTCs negative patients was 26.8 months. The difference was statistically significant. Stage 鈪，

本文编号：1839550