乳腺癌循环肿瘤细胞检测的临床价值
|
摘要
目的探讨乳腺癌循环肿瘤细胞(CTC)检测的临床意义。方法选取2016年5月至2018年4月南宁市第二人民医院乳腺甲状腺外科收治的111例乳腺癌确诊患者为研究对象,比较不同TNM分期患者CTC阳性率差异、乳腺癌术后患者化疗前后CTC阳性率差异、CTC阳性与阴性患者的化疗效果。结果Ⅰ期患者CTC阳性率为12.5%(2/16)、Ⅱ期患者阳性率为68.1%(47/69)、Ⅲ期患者阳性率为90.9%(20/22)、Ⅳ期患者阳性率为100.0%(4/4),四组患者间的CTC阳性率比较差异具有显著统计学意义(P<0.01);化疗(或内分泌治疗)前CTC检出阳性率为65.8%(73/111),显著高于化疗(或内分泌治疗)后的32.4%(36/111),差异具有显著统计学意义(P<0.01);化疗(或内分泌治疗)前CTC阳性与阴性两组患者化疗有效率比较,化疗(或内分泌治疗)前CTC检测为阳性患者有效率为30.1%,显著低于化疗(或内分泌治疗)前CTC检测为阴性患者的68.4%,差异具有显著统计学意义(P<0.01)。结论 CTC检测可作为乳腺癌的独立生物学因素,有助于全面病情评估、复发及转移的早期定位,而化疗后CTC阳性率显著下降,可有效预测乳腺癌辅助治疗的疗效与预后。
Objective To discuss the clinical significance of detection of circulating tumor cells(CTC) in breast cancer. Methods A total of 111 confirmed breast cancer patients admitted to the Department of Breast and Thyroid Surgery at the Second Nanning People's Hospital during May 2016 and April 2018 were selected as subjects. Differences were compared including the CTC positive rates among patients with different TNM stages, CTC positive rates before and after chemotherapy in patients with breast cancer, and chemotherapeutic effects in patients with positive or negative CTC. Results The positive rate of CTC was 12.5%(2/16) in stageⅠ, 68.1%(47/69) in stageⅡ, 90.9%(20/22) in stage Ⅲ, and 100.0%(4/4) in stage Ⅳ; the differences of CTC positive rate among the four groups of patients were statistically significant(P<0.01). The positive rate of CTC detection before chemotherapy(or endocrine therapy) was65.8%(73/111), which was significantly higher than 32.4%(36/111) after chemotherapy(or endocrine therapy); the difference was statistically significant(P<0.01). The efficiency of CTC positive and negative patients before chemotherapy(or endocrine therapy) was compared. The effective rate of CTC test positive before chemotherapy(or endocrine therapy) was 30.1%, significantly lower than 68.4% in patients with negative CTC test before chemotherapy(or endocrine therapy)(P<0.01). Conclusion CTC detection can be used as an independent biological factor for breast cancer, which is helpful for overall disease assessment and early location of recurrence and metastasis. The positive rate of CTC after chemotherapy is significantly decreased, which can effectively predict the efficacy and prognosis of adjuvant therapy for breast cancer. It is worthy of clinical promotion.
Objective To discuss the clinical significance of detection of circulating tumor cells(CTC) in breast cancer. Methods A total of 111 confirmed breast cancer patients admitted to the Department of Breast and Thyroid Surgery at the Second Nanning People's Hospital during May 2016 and April 2018 were selected as subjects. Differences were compared including the CTC positive rates among patients with different TNM stages, CTC positive rates before and after chemotherapy in patients with breast cancer, and chemotherapeutic effects in patients with positive or negative CTC. Results The positive rate of CTC was 12.5%(2/16) in stageⅠ, 68.1%(47/69) in stageⅡ, 90.9%(20/22) in stage Ⅲ, and 100.0%(4/4) in stage Ⅳ; the differences of CTC positive rate among the four groups of patients were statistically significant(P<0.01). The positive rate of CTC detection before chemotherapy(or endocrine therapy) was65.8%(73/111), which was significantly higher than 32.4%(36/111) after chemotherapy(or endocrine therapy); the difference was statistically significant(P<0.01). The efficiency of CTC positive and negative patients before chemotherapy(or endocrine therapy) was compared. The effective rate of CTC test positive before chemotherapy(or endocrine therapy) was 30.1%, significantly lower than 68.4% in patients with negative CTC test before chemotherapy(or endocrine therapy)(P<0.01). Conclusion CTC detection can be used as an independent biological factor for breast cancer, which is helpful for overall disease assessment and early location of recurrence and metastasis. The positive rate of CTC after chemotherapy is significantly decreased, which can effectively predict the efficacy and prognosis of adjuvant therapy for breast cancer. It is worthy of clinical promotion.
引文
[1]吴翔,岳春迪,崔小霞,等.多西紫杉醇与吡柔比星、环磷酰胺联合治疗进展期乳腺癌的效果评价[J].海南医学, 2018, 29(3):410-412.
[2]马磊,吴思培,邓旭斌,等. D-CIK治疗抑制进展期乳腺癌中循环肿瘤细胞的初步研究[J].海南医学, 2014, 12(13):1884-1887.
[3]王振丹,赵文华,李胜.循环肿瘤细胞检测方法研究现状[J].中华肿瘤防治杂志, 2014, 21(17):1391-1394.
[4]郑莹,吴春晓,张敏璐.乳腺癌在中国的流行状况和疾病特征[J].中国癌症杂志, 2013, 2(8):561-569.
[5] Apostolaki S, Perralo M, Pallis A, et al. Circulating HER2 mRNA positive cells in the peripheral blood of patients which stageⅠandⅡbreast cancer after the administration of adjuvant chemotherapy:evaluation of their clinical relevance[J]. Ann Oncol, 2007, 18(5):851-858.
[6] Hayes DF, Cristofanilli M, Budd GT, et al. Circulating tumor cells at each follow-up time point during therapy of metastatic breast cancer patients predict progression-free and overall survival[J]. Clin Cancer Res, 2006, 12(14Pt1):4218-4224.
[7] Camara O, Rengsberger M, Egbe A, et al. The relevance of circulating epithelial tumor cells(CETC)for therapy monitoring during neoadjuvant(primary systemic)chemotherapy in breast cancer[J]. Ann Oncol, 2007, 18(9):1484-1492.
[8]徐细明,陈嘉羽,嵩艳蓉,等.循环肿瘤细胞检测在乳腺癌疗效评价和预后判断中的研究进展[J].山东医药, 2016, 56(41):102-105.
[9] Tsuda H, Takarabe T, Hasegawa F, et al. Large, central acellular zones indicating myoepithelial tumor differentiation in high-grade invasive ductal carcinomas as markers of predisposition to lung and brain metastases[J]. Am J Surg Pathol, 2000, 24(2):197-202.
[10]杜兴,地力木拉提·艾斯木吐拉,栾梅香.循环肿瘤细胞在乳腺癌中的应用研究进展[J].中国普外基础与临床杂志, 2014, 21(9):1167-1172.
[11] Tewes M, Aktas B, Welt A, et al. Molecular profiling and predictive value of circulating tumor cells in patients with metastatic breast cancer:an option for monitoring response to breast cancer related therapies[J]. Breast Cancer Res Treat, 2009, 115(3):581-590.
[12] Ignatiadis M, Xenidis N, Perraki M, et al. Different prognostic value of cytokeratin-19 m RNA-positive circulating tumor cells according to estrogen receptor and HER2 status in early breast cancer[J]. J Clin Oncol, 2007, 25(33):5194-5202.
[13]龚丽,邹天宁.乳腺癌患者循环肿瘤细胞在预后和疾病进展中的作用[J].现代肿瘤医学, 2013, 21(8):1895-1899.
[14]徐细明,陈嘉羽,嵩艳蓉,等.循环肿瘤细胞检测在乳腺癌疗效评价和预后判断中的研究进展[J].山东医药, 2016, 56(41):102-105.
[15] Pachmann K, Camara O, Kavallaris A, et al. Monitoring the response of circulating epithelial tumor cells to adjuvant chemotherapy in breast cancer allows detection of patients at risks of early relapse[J].J Clin Oncol, 2008, 26(8):1208-1215.
[16] De Giorgi U, Valero V, Rohren E, et al. Circulating tumor cells and fluoro deoxyglucose positron emissiontomo graphy computed tomography for outcome prediction in metastaticbreast cancer[J]. J Clin Oncol, 2009, 27(20):3303-3311.
[17] NoléF, Munzone E, Zorzino L, et al. Variation of circulating tumor cell levels during treatment of metastatic breast cancer:prognostic and therapeutic implications[J]. Ann Oncol, 2008, 19(5):891-897.
[18]李阳,刘巍.乳腺癌循环肿瘤细胞临床应用的研究进展[J].河北医药, 2013, 35(2):270-272.
[2]马磊,吴思培,邓旭斌,等. D-CIK治疗抑制进展期乳腺癌中循环肿瘤细胞的初步研究[J].海南医学, 2014, 12(13):1884-1887.
[3]王振丹,赵文华,李胜.循环肿瘤细胞检测方法研究现状[J].中华肿瘤防治杂志, 2014, 21(17):1391-1394.
[4]郑莹,吴春晓,张敏璐.乳腺癌在中国的流行状况和疾病特征[J].中国癌症杂志, 2013, 2(8):561-569.
[5] Apostolaki S, Perralo M, Pallis A, et al. Circulating HER2 mRNA positive cells in the peripheral blood of patients which stageⅠandⅡbreast cancer after the administration of adjuvant chemotherapy:evaluation of their clinical relevance[J]. Ann Oncol, 2007, 18(5):851-858.
[6] Hayes DF, Cristofanilli M, Budd GT, et al. Circulating tumor cells at each follow-up time point during therapy of metastatic breast cancer patients predict progression-free and overall survival[J]. Clin Cancer Res, 2006, 12(14Pt1):4218-4224.
[7] Camara O, Rengsberger M, Egbe A, et al. The relevance of circulating epithelial tumor cells(CETC)for therapy monitoring during neoadjuvant(primary systemic)chemotherapy in breast cancer[J]. Ann Oncol, 2007, 18(9):1484-1492.
[8]徐细明,陈嘉羽,嵩艳蓉,等.循环肿瘤细胞检测在乳腺癌疗效评价和预后判断中的研究进展[J].山东医药, 2016, 56(41):102-105.
[9] Tsuda H, Takarabe T, Hasegawa F, et al. Large, central acellular zones indicating myoepithelial tumor differentiation in high-grade invasive ductal carcinomas as markers of predisposition to lung and brain metastases[J]. Am J Surg Pathol, 2000, 24(2):197-202.
[10]杜兴,地力木拉提·艾斯木吐拉,栾梅香.循环肿瘤细胞在乳腺癌中的应用研究进展[J].中国普外基础与临床杂志, 2014, 21(9):1167-1172.
[11] Tewes M, Aktas B, Welt A, et al. Molecular profiling and predictive value of circulating tumor cells in patients with metastatic breast cancer:an option for monitoring response to breast cancer related therapies[J]. Breast Cancer Res Treat, 2009, 115(3):581-590.
[12] Ignatiadis M, Xenidis N, Perraki M, et al. Different prognostic value of cytokeratin-19 m RNA-positive circulating tumor cells according to estrogen receptor and HER2 status in early breast cancer[J]. J Clin Oncol, 2007, 25(33):5194-5202.
[13]龚丽,邹天宁.乳腺癌患者循环肿瘤细胞在预后和疾病进展中的作用[J].现代肿瘤医学, 2013, 21(8):1895-1899.
[14]徐细明,陈嘉羽,嵩艳蓉,等.循环肿瘤细胞检测在乳腺癌疗效评价和预后判断中的研究进展[J].山东医药, 2016, 56(41):102-105.
[15] Pachmann K, Camara O, Kavallaris A, et al. Monitoring the response of circulating epithelial tumor cells to adjuvant chemotherapy in breast cancer allows detection of patients at risks of early relapse[J].J Clin Oncol, 2008, 26(8):1208-1215.
[16] De Giorgi U, Valero V, Rohren E, et al. Circulating tumor cells and fluoro deoxyglucose positron emissiontomo graphy computed tomography for outcome prediction in metastaticbreast cancer[J]. J Clin Oncol, 2009, 27(20):3303-3311.
[17] NoléF, Munzone E, Zorzino L, et al. Variation of circulating tumor cell levels during treatment of metastatic breast cancer:prognostic and therapeutic implications[J]. Ann Oncol, 2008, 19(5):891-897.
[18]李阳,刘巍.乳腺癌循环肿瘤细胞临床应用的研究进展[J].河北医药, 2013, 35(2):270-272.