非小细胞肺癌根治性化放疗前后外周血微转移的检测及其预后

Detection and prognostic significance of micrometastasis in peripheral blood of patients with nonsmall cell lung cancer treated by chemo-radiation therapy

目的探讨根治性化放疗治疗非小细胞肺癌（NSCLC）患者外周血微转移的预后意义。方法应用巢式CK19 RT-PCR方法,动态检测67例NSCLC患者根治性化放疗前后外周血微转移,研究其与临床病理特征的相关性和预后价值。结果治疗前和治疗后,微转移阳性分别为44例（65．7％）和22例（32．8％）;治疗前,微转移表达与N分期（P=0．014）相关;治疗后,微转移表达与N分期（P=0．032）、病理类型（P=0．019）、体重减轻（P=0．01）和KPS评分（P=0．027）相关;治疗前微转移阳性和阴性的4年远处转移率分别为78．3％和70．4％（P=0．544）,治疗后分别为100％和62．9％（P〈0．001）。治疗前微转移阳性和阴性患者的中位生存期分别为13．8个月和17．6个月, 4年生存率分别为18．2％和17．4％（P=0．619）。治疗后微转移阳性和阴性患者的中位生存期分别为7．8个月和27．6个月,4年生存率分别为0和26．4％（P〈0．001）。多因素分析显示,治疗后微转移阳性是一独立不良预后因素（P=0．000）。结论根治性化放疗后,外周血微转移的检测有预后价值;与微转移阳性相比,阴性患者预后好。

Objective To investigate the prognostic significance of micrometastasis （MM） in peripheral blood of patients with non-small cell lung cancer （ NSCLC ） treated by chemo-radiation therapy. Methods Peripheral blood was taken from 67 NSCLC patients before and after definitive chemo-radiation therapy. CK19 mRNA of the peripheral blood was measured by nested RT-PCR and both their relationship with clinicopathological features and prognostic significance were further investigated. Results The micrometastasis-positive rates were 65.7 % （44/67） and 32.8% （22/67）, respectively, before and after the treatment. The micrometastasis-positive rate before treatment was closely in correlation with N-stage （P = 0.014）. In contrast, it turned out to be more closely related with histological types （ P = 0. 019）, weight loss （ P = 0.01 ）, KPS status （ P = 0.027 ） as well as N-stage （P = 0.032） after chemo-radiation therapy. 4-yr distant metastasis rates （DMR）for micrometastasis-positive and -negative patients were 78.3% and 70.4%, respectively, before the treatment （ P = 0. 544） while they were 100% and 62.9%, respectively, after the chemoradiation （ P 〈 0. 001 ）. The median survival time （MST） and 4-yr overall survival rate （OSR） for pretreatment micrometastasis-positive and -negative patients were 13.8 months and 17.6 months, and 18.2% and 17.4%, respectively （ P = 0. 619 ）, while for post-treatment micrometastasis-positive and -negative patients they were 7.8 months and 27.6 months and 0 and 26.4%, respectively（P 〈 0. 001 ）. Multivariate analysis showed that the post-treatment positive micrometastasis was an independent unfavorable prognostic factor（ P = 0. 000 ） . Conclusion detection of micrometastasis in peripheral blood may possess a prognostic significance after definitive chemo-radiation therapy. Micrometastasis-negative patients have better prognosis compared to those with positive micrometastasis.