早中期结直肠癌患者外周血鸟苷酸环化酶mRNA和细胞角蛋白20mRNA检测及预后分析

Detection of guanylate cyclase C mRNA and cytokeratin 20 mRNA in peripheral blood and analysis of prognosis in early to moderate colorectal cancer patients

目的探讨外周血鸟苷酸环化酶（GC．C）mRNA和细胞角蛋白20（CK20）mRNA水平与早中期结直肠癌患者肿瘤转移及预后的关系。方法应用荧光定量聚合酶链反应技术，检测74例早中期结直肠癌患者术前外周血GC．CmRNA以及CK20mRNA的表达．并结合临床和病理各项指标以及术后随访资料，对患者肿瘤转移危险因素和预后进行统计学分析和评价。结果74例结直肠癌患者外周血GC．CmRNA阳性率为33．8％（25／74），CK20mRNA阳性率为31．1％（23／74）；1、2、3年无瘤生存率分别为94．6％、82．4％和78．4％。单因素预后分析发现，外周血GC．cmRNA、CK20mRNA、肿瘤分化类型、有无肠系膜根部淋巴结转移、有无脉管瘤栓和术后是否接受化疗6因素与本组患者3年无瘤生存有关（均P〈0．05）；有无肠系膜根部淋巴结转移和有无脉管瘤栓是预后的独立影响因素（P〈0．05）。按肿瘤分期分层分析，外周血CK20mRNA和有无脉管瘤栓是Ⅲ期结直肠癌患者3年无瘤生存率的独立影响因素（P〈O．05）。结论检测外周血CK20mRNA、GC—CmRNA对于早期发现早中期结直肠癌转移可能具有重要的临床意义。

Objective To investigate the associations of guanylate cyclase C（GC-C） mRNA and cytokeratin 20 （CK20） mRNA with metastasis and prognosis in early to moderate colorectal cancer patients. Methods GC-C mRNA and CK 20 mRNA in peripheral blood of 74 colorectal cancer patients without distant metastasis were detected by fluorescent quantitative PCR （FQ-PCR）. Based on their clinicopathological and postoperative follow-up data, the relationship and clinical significance of these data with metastasis hazards and prognosis factors were analyzed. Results The positive rate of GC-C mRNA in 74 colorectal cancer patients was 33.8%（25/74）, and CK20 mRNA was 31.1% （23/74）. The 1-, 2-, 3- year disease-free survival rates of patients were 94.6%,82.4% and 78.4% respectively. There were significant differences in positive rates of GC-C mRNA and CK20 mRNA, tumor differentiation, mesentery lymph node metastasis, tumor embolus in vessel and postoperative chemotherapy associated with 3-year disease free survival rate by Kaplan-Meier analysis （all P〈0.05）. While mesentery lymph node metastasis and tumor embolus in vessel were independent risk factors of 3-year disease-free survival （P〈0.05）. CK20 mRNA and tumor embolus in vessel were independent risk factors of 3-year disease-free survival by analysis stratified with clinical stage （P〈0.05）. Conclusions Detection of CK20 mRNA and GC-C mRNA in peripheral blood may be important for early detection of early metastasis of colorectal cancer.