循环肿瘤细胞数量的变化情况对HER2阳性早期乳腺癌患者治疗效果及预后的影响

The effect of changes in circulating tumor cell count on the clinical effect and prognosis of HER2 positive early stage breast cancer patients

目的探讨人表皮生长因子受体2(HER2)阳性早期乳腺癌患者治疗前后外周血中循环肿瘤细胞(CTC)数量的变化对治疗效果的影响及对患者预后的预测意义.方法根据患者的病情和意愿选择治疗方案,根据治疗方案的不同将166例HER2阳性早期乳腺癌患者分为曲妥珠单抗辅助治疗组98例和手术组68例.观察两组患者治疗前后CTC数量的变化和细胞角蛋白19(CK19)的表达水平,比较两组患者的治疗效果和预后.结果两组患者的外周血中均存在CTC.治疗3个月后,手术组患者的CTC检出率、CTC检出数目均少于曲妥珠单抗组患者,两组患者的CK19检出率、CK19 mRNA的表达水平均低于本组化疗前,差异均有统计学意义(P﹤0.05).化疗前、化疗结束后1个月和治疗3个月后,两组患者的CK19检出率、CK19 mRNA表达水平比较,差异均无统计学意义(P﹥0.05).结论 HER2阳性早期乳腺癌患者外周血中CTC的存在与乳腺癌的发生密切相关,CTC数目减少可以作为HER2阳性早期乳腺癌患者治疗效果提高和预后情况改善的预测性指标,CTC检测可指导临床医师对HER2阳性早期乳腺癌患者的预后情况进行评估,手术应作为HER2阳性早期乳腺癌患者化疗后的首选治疗方式.

Objective To investigate the influence of the circulating tumor cells (CTC) count in peripheral blood of patients with human epidermal growth factor receptor 2 (HER2) positive early stage breast cancer on the clinical effect, and to evaluate its predictive value for the prognosis of patients. Method According to the patient’s condition and willingness to choose the treatment plan, a total of 166 cases of operable HER2 positive early breast cancer were included in the research as trastuzumab group (98 cases) and surgery group (68 cases) according to different treatment methods. The changes in the count of CTC and the expression level of cytokeratin 19 (CK19) were measured before and after treatment in the two groups, and the therapeutic effect and prognosis of the two groups were evaluated. Result CTC were observed in the peripheral blood of all HER2 positive early stage breast cancer patients. In 3 months after treatment, the detection rate and detected count of CTC in study group were lower than those in trastuzumab group (P<0.05). Besides, during the same period, the detection rate of CK19 and expression of CK19 mRNA were decreased in both groups compared with that before treatment, showing statistically significant difference (P<0.05). Before chemotherapy, in 1 month after chemotherapy and in 3 months after treatment, the detection rate of CK19 and expression of CK19 mRNA in the two groups were of no statistically significant difference (P<0.05). Conclusion The expression of CTC in peripheral blood of patients with HER2 positive early stage breast cancer is closely related to the occurrence of the disease. The decrease of CTC count can be used as a predictive indicator for the improvement of treatment effect and HER2 positive early stage breast cancer patients’prognosis, thus the CTC count is conducive to the assessment of clinical prognosis of patients with HER2 positive early stage breast cancer after surgery.