食管鳞癌放疗前后外周血survivin检测的临床意义

Clinical significances of survivin mRNA detection in peripheral blood of esophageal cancer patients treated with radiotherapy

目的:研究食管鳞癌(esophagus squamous cell carcinoma,ESCC)患者放疗前后外周血循环肿瘤细胞(circulating tumorcells,CTCs)标记生存素(survivin)mRNA的表达及其临床意义。方法:收集72例ESCC患者根治性放疗前后外周血,应用巢式RT-PCR检测survivin mRNA的表达,分析其与临床病理特征、放疗疗效及两年无进展生存期(progerssion-free survival,PFS)的关系。结果:放疗前后survivin mRNA阳性者分别占54.2%(39/72)与38.9%(28/72),差异无统计学意义(P=0.066),放疗前后survivin mRNA阳性均与淋巴结转移相关(P值分别为0.012和0.005),放疗后survivin mRNA阳性提示放疗疗效不佳(P=0.030)。生存分析表明放疗前后survivin mRNA阳性与PFS减少有关(P值分别为0.040和<0.001),Cox回归模型证实放疗后survivin mRNA阳性、KPS评分和规范化后续化疗是独立预后指标。结论:放疗后外周血survivin mRNA阳性有望成为ESCC根治性放疗疗效评估和预后判断的有效分子标记。

Objective： To study clinical significances of survivin expression,a marker of circulating tumor cells（CTC）,in peripheral blood of esophagus squamous cell carcinoma（ESCC） patients treated with radiotherapy. Methods： Survivin mRNA expression was determined using nest RT-PCR in pre-and post-radiotherapy blood of 72 esophageal cancer patients with radiotherapy, and its associations with clinicopathological features, radiotherapy response and 2-year progression-free survival （PFS） were further evaluated. Resuits： The positive expression of survivin mRNA in pre-and post-radiotherapy were 54.2% （39/72） and 38.9% （28/72）, respectively, and the difference has not statistical significance （P = 0.066）. Furthermore,survivin mRNA expression was associated with lymph metastasis both in pre- and post-radiotherapy （P = 0.012 and P = 0.005,respectively）. Survivin expression of post-radiotherapy was associated with poor radiotherapy response （P = 0.030）. Kaplan-Meier analysis also showed that survivin mRNA expression predicted adverse 2-year PFS both in pre- and post-radiotherapy（P = 0.023 and P 〈 0.001 ）. However, Cox proportional hazard models indicated that only post-radiotherapy survivin mRNA expression apart from KPS scores and standard chemotherapy were independent prognostic factors for ESCC. Conclusion： Post-radiotherapy survivin mRNA expression may be an useful biomarker related to poor radiotherapy response and adverse prognosis in ESCC patients treated with radiotherapy.