CK20 mRNA在腹腔镜结直肠癌根治术后对肿瘤细胞血循环微转移的影响

Effect of CK20 mRNA on hematogenous micrometastasis in laparoscopic radical resection

目的:探讨血清CK20mRNA与结直肠癌组织学、TNM分期的关系以及腹腔镜结直肠癌根治术后对肿瘤细胞血循环微转移的影响及其临床意义.方法:应用FQ-PCR方法检测20例健康成人(对照组)及55例结直肠癌患者(实验组),不同术式、手术前、后外周静脉血CK20mRNA的表达;分析血清CK20mRNA与肿瘤组织分化、TNM分期的关系.比较24例腹腔镜辅助下行结直肠癌根治术患者和31例传统开腹根治术患者外周静脉血CK20mRNA的表达.结果:对照组外周静脉血CK20mRNA阳性表达率为0;CK20mRNA阳性率(0.75)明显高于高、中分化腺癌组(0.23)(P<0.05).TNM分期Ⅲ期结直肠癌组外周静脉血CK20mRNA阳性表达率(0.43)显著高于Ⅰ期+Ⅱ期患者(0.22)(P<0.05).腹腔镜辅助下行结直肠癌根治术患者CK20mRNA阳性率术前(0.29),术后(0.38),与开腹组相比较差异均无统计学意义.结论:结直肠癌患者外周静脉血CK20mRNA水平与肿瘤分化、TNM分期有关;腹腔镜辅助下行结直肠癌根治术与传统开腹手术一样,并不增加外周静脉血CK20mRNA的阳性率和术后肿瘤血循环微转移的危险性.

AIM： To investigate the effect of CK20 mRNA on the hematogenous micrometastasis in laparoscopic radical resection. METHODS： Fluorescence quantitative polymerase chain reaction （FQ-PCR） was used to detect the preoperative and postoperative CK20 mRNA in the peripheral blood in 55 colorectal cancer patients treated by different surgical approach （experiment group） , and 20 healthy adults were included in control group. The relationship between serum CK20 mRNA and TNM stages as well as tumor differentiation was studied and the CK20 mRNA expression of 24 colorectal cancer patients treated with laparoseopic radical surgery was compared with that of 31 patients treated by traditional laparotomy. RESULTS： The CK20 mRNA expression in control group was negative. The CK20 mRNA expression in patients with low differentiation cancers was significantly higher than that in patients with high/moderate differentiation cancers （0.75 vs 0. 23, P 〈 0.05）. The CK20 mRNA expression of patients at phase Ⅲ significantly higher than that in patients at phase Ⅰ/Ⅱ （ P 〈 0. 05 ）. No significant difference was found between preoperative and postoperative positive rate of CK20 mRNA in patients treated by laparoscopic radical resection and no significant difference was found between the laparoscopic and open radical resection of colorectal cancer preoperatively or postoperatively. CONCLUSION： Serum CK20 mRNA in the peripheral venous blood is related to the TNM staging and tumor differentiation. Compared with traditional laparotomy, laparoscopic radical resection of colorectal cancer will not increase the positive rate of CK20 mRNA in the peripheral blood and the risk of hematogenous micrometastasis of tumor ceils.