外周血循环肿瘤细胞对早期胃癌的诊断和预后评估价值

Diagnostic and prognostic value of peripheral circulating tumor cells in early gastric cancer

目的探讨外周血循环肿瘤细胞(CTC)对早期胃癌(EGC)的诊断和预后评估价值。方法经胃镜检查发现胃黏膜病变、疑似EGC的189例患者根据病理诊断分为64例EGC患者和125例非EGC患者。采用Cell Search系统检测所有患者的CTC表达情况,以病理诊断结果为金标准,评价CTC的诊断效能。比较不同临床特征EGC患者的CTC表达情况,分析影响EGC患者预后的因素。结果 189例患者中,24例患者的CTC呈阳性,均为EGC患者,CTC诊断EGC的灵敏度为37.50%,特异度为100%,阳性预测值为100%,阴性预测值为75.76%,准确率为78.84%。CTC阳性与CTC阴性EGC患者的淋巴结转移情况、脉管癌栓情况比较,差异均有统计学意义(P﹤0.01)。CTC阳性、有淋巴结转移、有脉管癌栓的EGC患者的复发或转移率均高于CTC阴性、无淋巴结转移、无脉管癌栓的患者,差异均有统计学意义(P﹤0.05);不同性别、年龄、肿瘤位置、浸润深度、分化程度和大体病理类型的EGC患者的复发或转移情况比较,差异均无统计学意义(P﹥0.05)。结论应用Cell Search系统检测CTC对EGC的诊断效能较低,但可作为淋巴结转移和预后不良的参考指标。

Objective To study the diagnostic and prognostic value of peripheral circulating tumor cells (CTC) in early gastric cancer (EGC). Method A total of 189 patients with gastric mucosal lesion and suspected EGC under gastroscopy were included in the study. After pathological examination, 64 were diagnosed as EGC and 125 were diagnosed as nongastric cancer. Cell Search system was used to detect the CTC in all patients. The diagnostic efficiency of CTC was evaluated with pathological diagnosis as the gold standard. CTC expression in EGC patients with different clinical characteristics were compared, and the factors affecting the prognosis of patients with EGC were analyzed. Result Twenty-four out of 189 patients were with positive CTC, all of them were EGC patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of CTC for diagnosing EGC were 37.50%, 100%, 100%, 75.76% and 78.84%, respectively. There were significant differences in lymph node metastasis and vascular carcinoma thrombus between patients with positive and negative CTC (P<0.01). The recurrence or metastasis rate of patients with positive CTC, presence of lymph node metastasis and vascular carcinoma thrombus was significantly higher than those with negative CTC, absence of lymph node metastasis and vascular carcinoma thrombus (P<0.05);nonetheless, there were no statistically significant differences on recurrence or metastasis rate among different gender, age, tumor location, depth of invasion, degree of differentiation and general pathological types in EGC patients (P>0.05). Conclusion CTC detected by Cell Search system is inefficient in the diagnosis of EGC, but it can be used as a reference index for lymph node metastasis and poor prognosis.