晚期卵巢癌患者外周血循环肿瘤细胞的检测及其临床意义

摘要

Objective:To investigate the detection and clinical significance of circulating tumor cells in the peripheral blood of advanced ovarian cancer patients.Methods:The data of 60 patients with advanced ovarian cancer treated in the Medical Oncology Department of Yongzhou Central Hospital from June 2014 to June 2016 were selected as the study group,while 30 patients of healthy volunteers were selected as the control group.Extracted 7.5 ml peripheral blood from the patients respectively.With folw cytometer,the CTC expression with EpCAM and cytokeratin-19 positive while CD45 negative in the two groups were detected before and after two cycles chemotherapy.Then analyzed its relationship between clinical features and chemical effect and the relationship between the CTC numbers and the response evaluation criteria in solid tumors before and after two cycles chemotherapy.Then follow-up the patients' progression-free survival(PFS) and analysis the relationship between the number of CTC and PFS on patients undergoing treatment.Results:42 cases were detected CTC express in the observation group,and the positive rate was 70%.While there was not detected CTC express in the control group.The difference was significance between the two groups(P<0.05).CTC expression was relevant to the differentiation and expression of CA125(P<0.05),but it was not relevant to the age,tumor diameter and ascites(P>0.05).Before chemotherapy,42 cases were detected CTC expression.While after two cycles chemotherapy,18 cases were detected CTC expression,and the significance was statistically difference(P<0.05).After two cycles chemotherapy,there was no statistically difference in the evaluation of chemotherapy effects between the CTC numbers and the Response Evaluation Criteria in Solid Tumors(P>0.05),and had a certain degree of fit(k=0.479).In the correlation analysis,the CTC numbers was correlated with the clinical efficacy(r=-0.223,P=0.009).After two cycles chemotherapy,the numbers of circulating tumor cells in peripheral blood<5,the survival time was 13.2(11.0~15.1)months;The number of circulating tumor cells in peripheral blood ≥ 5,the survival time was 6.4(3.8~9.2)months.The difference was significance between the two groups(P<0.05).Conclusion:The positive rate of CTC was relevant to the differentiation and expression of CA125,as well as chemotherapy effect.The positive rate of CTC may predict the chemotherapy effects on the advanced ovarian cancer patients.%目的:探讨晚期卵巢癌患者外周血中循环肿瘤细胞(CTC)的检测及其临床意义.方法:选择2014年6月至2016年6月永州市中心医院收治的60例晚期卵巢癌患者作为观察组,收集同期本院的30例健康志愿者作为对照组.分别抽取外周血7.5 ml,采用流式细胞仪检测卵巢癌患者一线方案化疗2周期前后及对照组外周血中EpCAM、CK19同时(+)且CD45(-)的CTC的变化情况,同时分析其与临床特征及化学疗效的关系以及比较化疗前后CTC数目评价与RECIST疗效评价标准之间的关系,并随访患者的无进展生存期(PFS),分析患者治疗过程中CTC数目的变化与患者PFS的关系.结果:观察组中42例检测到CTC,阳性率70%,对照组未检测到CTC,两组比较,差异具有统计学意义(P<0.05).CTC阳性表达情况与卵巢癌患者的分化程度及CA125表达相关(P<0.05),与患者的年龄、肿瘤直径、腹水情况均无相关性(P>0.05).观察组中化疗前CTC阳性表达42例,阳性率为70%,化疗2周期后卵巢癌患者CTC阳性表达18例,阳性率为30%,两组差异具有统计学意义(P<0.05).化疗2周期后,CTC数目评价与RECIST疗效评价标准之间差异无统计学意义(P>0.05),且两种方法的吻合度较高(k=0.479).运用相关分析显示,CTC表达与化学疗效呈负相关(r=-0.223,P=0.009).化疗2周期后外周血中循环肿瘤细胞数目<5,其无进展生存期为13.2(11.0~15.1)个月,外周血中循环肿瘤细胞数目≥5,其无进展生存期为6.4(3.8~9.2)个月,两组差异具有统计学意义(P<0.05).结论:CTC阳性表达与卵巢癌患者的分化程度及CA125表达相关,与化疗疗效呈负相关,CTC的表达情况可以预测卵巢癌患者的化疗疗效及预后.