外周血活性循环肿瘤细胞与非小细胞肺癌患者临床特征的相关性及其临床意义

摘要

目的 初步探讨外周血活性循环肿瘤细胞(CTC)与非小细胞肺癌(NSCLC)患者临床特征的相关性及其临床意义.方法 选取2017年6月至2018年8月于首都医科大学附属北京安贞医院呼吸与危重症医学科住院且经影像及病理学检查确诊的NSCLC患者51例(观察组),其中腺癌38例,鳞癌13例;并收集同期该科室住院的21例良性肺疾病患者(良性肺疾病组)及该院健康体检者18名(健康对照组).应用含重组病毒的CTC体外检测试剂盒检测各组外周血中活性CTC数量,并分析比较活性CTC表达情况与NSCLC患者临床、病理学特征的关系.结果 观察组44例CTC阳性,良性肺疾病组4例CTC阳性,健康组未检出;该检测方法的敏感度为86.3％ (44/51),特异度为89.7％ (35/39).每6 ml外周血中检测出活性CTC的数量在不同的临床分期(Ⅰ～Ⅱ期比Ⅲ～Ⅳ期)及有无远处转移(M0比M1)组间比较差异有统计学意义[1(0,6)个比3(0,54)个、1(0,2)个比3(1,8)个](Z=-2.041、-2.623,P=0.041、0.009).使用Logistic回归模型分析得出,外周血活性CTC数量的增加与NSCLC患者发生远处转移的风险独立相关(比值比=1.356,95％置信区间1.015 ～1.811,P=0.040);当外周血CTC数量大于3个/6ml时,NSCLC患者发生远处转移的风险增加了近5倍(比值比=5.356,95％置信区间1.341～21.400,P=0.018).结论 外周血活性CTC检测作为一种简便、无创的检测手段,特异度和敏感度均较高,可能提早预测NSCLC患者的远处转移.%Objective To explore the relation between peripheral blood active circulating tumor cell (CTC) and clinical characteristics of non-small cell lung cancer(NSCLC).Methods From June 2017 to August 2018,51 NSCLC patients confirmed by imaging and pathological results were recruited in Beijing Anzhen Hospital,Capital Medical University(observation group),including 38 cases of adenocarcinoma and 13 cases of squamous cell carcinoma;21 patients with benign lung disease were recruited as benign lung disease group;18 healthy people were recruited as healthy control group.Peripheral blood active CTC was detected in vitro using recombinant virus vectors.Relation between the expression of CTC and the clinical and pathological features of NSCLC was analyzed.Results There were 44,4 and 0 positive CTC cases in NSCLC group,benign lung disease group and healthy control group,respectively.Sensitivity and specificity of CTC detection were 86.3％ (44/51) and 89.7％ (35/39).Numbers of active CTC in 6 ml peripheral blood showed significant differences between clinical stage Ⅰ-]Ⅱ and Ⅲ-Ⅳ,with and without distant metastasis(M0 vs M1) [1 (0,6) vs 3(0,54),1 (0,2) vs 3(1,8)](Z =-2.041,-2.623;P =0.041,0.009).Logistic regression showed that peripheral blood CTC level was independently associated with high risk of distant metastasis (odds ratio =1.356,95％ confidence interval:1.015-1.811,P =0.040);the risk of distant metastasis in NSCLC patients with peripheral blood CTC more than 3/6 ml increased nearly five times (odds ratio =5.356,95％ confidence interval:1.341-21.400,P =0.018).Conclusion Peripheral blood CTC detection,as a simple and noninvasive method,has high specificity and sensitivity in predicting distant metastasis of NSCLC.