非小细胞肺癌患者术后化疗过程中外周血CK19 mRNA表达水平的变化及其临床意义

The level of cytokeratin19(CK19)mRNA in peripheral blood based on postoperative chemotherapy in patients with non-small cell lung cancer by real time fluorescence RT-PCR

目的探讨定量检测外周血CK19 mRNA表达水平在判定术后辅助治疗疗效及早期预测肿瘤复发中的价值。方法接受以根治为目的的手术治疗的非小细胞肺癌(NSCLC)患者共26例,分别于术后化疗开始前、第1、2、3周期化疗结束后第3周各采集外周血标本。对照组为健康体检者(n=20)。运用实时荧光定量逆转录-聚合酶链反应法(fqRT-PCR)检测各时点外周血中CK19 mRNA水平。结果化疗前患者外周血CK19 mRNA表达水平显著高于第1、2、3周期化疗后。阳性率从化疗前的84.6%分别下降至46.2%、38.5%及46.2%(P=0.0046)。术后有临床转移/复发患者外周血CK19 mRNA表达水平显著高于无临床转移/复发者(P=0.019)。结论术后定期监测外周血CK19 mRNA表达水平可作为判定术后辅助治疗疗效的重要标准。术后动态监测有助于预测NSCLC复发或转移。化疗难以完全消灭外周循环癌细胞,需寻找新的治疗方法或靶点。

Objective To explore the value of the level of cytokeratinl9（CK19）mRNA in peripheral blood based on postoperative chemotherapy in patients with non small cell lung cancer. Methods The samples of peripheral blood were taken from each lung cancer patients （n= 26） that had undergone an operation for curable intension at the day before postoperative chemotherapy as well as the third week after the first, second and third cycle of chemotherapy and subjected to real-time fluorescent quantitative RT-PCR assay for CK19 mRNA. All cases were followed up by current available elinicopathological means. Results The expression level of CK19 mRNA before postoperative chemotherapy was significantly higher than that of the first,second and third cycle. The percentage of the fqRT-PCR positive rate decreased from 84.6% （22/26） before chemotherapy to 46.2% （12/26） ,to 38.5% （10/26） ,and to 46.2 （12/26） after 1,2, and 3 cycle（s）, respectively （P = 0. 004 6）. The expression level of CK19 transcripts in patients with clinical relapse/metastases was significantly higher than that of patients without relapse/metas-tases. Conclusion Longitudinal monitoring the level of CK19 mRNA in peripheral blood should be considered as an effective criterion for assessing efficacy of postoperative chemotherapy regimen. A monitoring procedure of this type would be of considerable value. Meanwhile,it is helpful to predict the relapse/metastasis of lung cancer after surgery. As it is impossible to completely eliminate circulating tumour cells（CTCs） by chemotherapy,looking for a new treatment strategy or other target is urgent.