肺癌术中血癌胚抗原mRNA的检测及意义

Detection of blood dissemination during the operation of lung cancer and its significance

目的探讨肺癌术中有无肿瘤细胞的血行播散及其规律。方法对52例肺癌、5例肺部良性病变手术患者,于开胸时、结扎肺静脉时及结扎后1h取外周静脉血,结扎肺静脉时取肺静脉血,采用巢式逆转录聚合酶链反应(RTPCR)技术检测血中癌胚抗原(CEA)mRNA的表达量(以经内参照校正的紫外灯光下灰度值表示)。取人腺癌细胞系A549作阳性对照并检测该方法的灵敏度。结果CEAmRNA检测阳性率开胸时为31%(16/52),结扎肺静脉时外周血与肺静脉血、结扎肺静脉后1h外周静脉血均为54%(28/52),且病例一致。开胸时的CEAmRNA表达水平最低95±20,结扎肺静脉时肺静脉血最高126±22,结扎肺静脉时外周静脉血与结扎肺静脉后1h的外周静脉间差异无统计学意义(P>0.05)。CEAmRNA的术中阳性率,鳞癌患者为64%(14/22),腺癌患者为47%(14/30),阳性率与肿瘤性质无关(χ2=1.47,P>0.05);中央型肺癌的术中阳性率(80%,20/25)显著高于周围型肺癌(30%,8/27)(χ2=16.81,P=0.000);TNM分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期者阳性率分别为32%(8/25),55%(6/11),93%(14/15)和0(0/1),分期较晚者显著高于分期较早者(χ2=17.93,P=0.000)。5例阴性对照均为阴性。经检验该方法的灵敏度为1×10-6。结论肺癌术中的确存在血行播散,结扎肺静脉的早晚可能对瘤细胞播散量有较大影响;

Objective To evaluate the possibility of dissemination of lung cancer cells through blood during the operation for lung cancer. Methods The blood samples were taken from 52 patients with non-small cell lung cancer(NSCLC) and 5 patients with benign lung diseases at four different intervals during the operation. The transcription of carcinoembryonic antigen(CEA) messenger ribonucleic acid was assayed by means of nested reverse transcriptase polymerase chain reaction (RT-PCR). A549 ( a human adenocarcinoma cell line ) served as positive control. The sensitivity has been tested using quantificationally diluted A549 cells. Results The CEA mRNA positive rates of all four time spots are as follows: 31%(16/52) at beginning of the operation (sample taken from peripheral vein), 54%(28/52) at ligating the pulmonary vein (peripheral vein), 54%(28/52) at ligating the pulmonary vein (pulmonary vein) and 54%(28/52) at 1 hour after ligating the pulmonary vein (peripheral vein ). There is no relationship between the tumor identity and the positive rate of CEA mRNA. The positive rate of CEA mRNA is higher in patients with centrally located lung cancer than that in patients with peripherally located lung cancer, similar phenomenon is also found between patients with advanced lung cancer and the patients with early stage of lung cancer. No negative control samples was found to be positive for CEA mRNA, the sensitivity of our test was 1×10^-6 . Conclusions The cancer cell dissemination during operation was demonstrated indirectly in our study, the time of pulmonary vein ligation (later or earlier) may affect the quantity of tumor cells released into circulation. Patients with lung cancer of central type and late TNM stage have more possibility of cancer cell dissemination during operation. More effective means may be needed to avoid the dissemination of cancer cells.