乳腺癌新辅助化疗中循环肿瘤细胞的动态变化及疗效观察

Efficacy of neoadjuvant chemotherapy on breast cancer and dynamic changes of circulating tumor cells

目的：通过检测新辅助化疗乳腺癌患者化疗前及化疗后各周期外周血中循环肿瘤细胞的变化，比较TC及TEC两种不同新辅助化疗方案的疗效。方法：选取2010年1月～2012年12月间本院收治的96例局部晚期乳腺癌患者，随机分为两组，分别给予TC（多西他赛＋环磷酰胺）和TEC（多西他赛＋表柔比星＋环磷酰胺）两种方案4个周期。分别抽取新辅助化疗前、新辅助化疗1、2、3、4个疗程后48h患者外周血5 mL，并采用流式细胞术测量外周血中循环肿瘤细胞含量，比较两种新辅助化疗方案疗效。结果：两组患者新辅助化疗前年龄、绝经状态、ER、PR、C-erbB-2、肿物大小、临床分期等一般资料无统计学差异；两组患者新辅助化疗前外周血中循环肿瘤细胞值无明显差异；新辅助化疗前，两组患者外周血中循环肿瘤细胞含量与肿物体积有关系，肿物〉5 cm者循环肿瘤细胞含量明显高于肿物≤5 cm者（P均〈0.05）；两种新辅助化疗方案化疗后，两组患者外周血中循环肿瘤细胞值随化疗周期进行而持续降低（P均〈0.05），同时，使用TEC方案患者外周血中循环肿瘤细胞值明显低于使用TC方案患者（P均〈0.05）。结论：使用TC和TEC方案新辅助化疗可使局部晚期乳腺癌患者病灶缩小，外周血中循环肿瘤细胞值降低。同时，监测外周血中循环肿瘤细胞值变化，可评价新辅助化疗方案疗效。

Objective： This study aims to investigate the neoadjuvant chemotherapy effect of TC and TEC by detecting the change of circulating tumor cells （CTC） in peripheral blood before and after every neoadjuvant cycle of breast cancer patients. Meth-ods：A total of 96 locally advanced breast cancer patients were selected in our hospital from January 2010 to December 2012. These pa-tients were divided into TC （docetaxel and cyclophosphamide） group and TEC （docetaxel, epirubicin and cyclophosphamide） group. Ve-nous blood （5 mL） was extracted from 96 patients prior to neoadjuvant chemotherapy, 48 h after the first, second, third, and fourth cy-cles of neoadjuvant chemotherapy. The CTC values of these two groups of patients were detected by flow cytometry, and their chemo-therapy effect was compared. Results： No significant difference was observed for age, menopausal status, ER, PR, C-erbB-2, tumor size, and clinical stage between the two groups of patients before chemotherapy and for CTC between the two groups before chemother-apy. Before neoadjuvant chemotherapy, the CTC values were correlated with tumor size. The CTC values for patients with tumor size〉5 cm were higher than those with tumor size〈5 cm. After neoadjuvant chemotherapy, the CTC values of the two groups of patients de-creased （P〈0.05）, and the CTC values of the TEC group were lower than those of the TC group （P〈0.05）. Conclusion：After TC or TEC neoadjuvant chemotherapy, the tumors of patients were smaller, and the CTC values were lower than those prior to neoadjuvant chemotherapy. The efficacy of neoadjuvant chemotherapy can be evaluated by monitoring the values of circulating tumor cells in pe-ripheral blood changes.