外周血hTERT mRNA表达与进展期结直肠癌术后复发及预后的关系

Correlation between quantitative detection of hTERT mRNA in peripheral blood and postoperative recurrence and prognosis in patients with advanced colorectal cancer

目的 探讨进展期结直肠癌（CRC）患者外周血人端粒酶逆转录酶（hTERT） mRNA表达量与术后复发及预后的关系.方法 以实时荧光定量RT-PCR定量检测85例进展期CRC患者根治术前、术后1个月及30例健康对照者外周血hTERT mRNA表达量;术后随访3年,CRC复发患者及未复发患者复查外周血hTERT mRNA表达量.结果进展期CRC组术前外周血hTERT mRNA表达量显著高于正常对照组[（6.22 ±5.85）2-△△Ct vs （0.45 ±0.27）2-△△Ct,P ＜0.01],术后1个月外周血hTERT mRNA表达量显著降低（P＜0.01）.术后复发组外周血hTERT mRNA表达量显著高于术后1个月组和未复发组[（5.07 ±2.87）2-△△Ctvs（1.83±1.08）2-△△Ct,（2.15 ±1.49）2-△△Ct,（P＜0.01）].单因素分析显示肿瘤分化程度、肿瘤大小、淋巴结转移率及有无肝转移是影响进展期CRC患者术前外周血hTERT mRNA表达水平升高的因素（P＜0.05或P＜ 0.01）.Logistic多因素回归分析显示肿瘤分化程度、淋巴结转移及肝转移为影响进展期CRC术前外周血hTERT mRNA表达升高的独立危险因素;随着术前外周血hTERT mRNA表达量的升高,CRC患者术后3年复发率逐步升高,术后生存率逐步降低.结论术前外周血hTERTmRNA表达量与进展期CRC重要病理特征相关,是影响预后的重要因素,可作为预后评价指标;术后外周血hTERT mRNA表达量升高与术后复发相关.

Objective To investigate the correlation between expression of human telomerase reverse transcriptase （hTERT） mRNA in peripheral blood and postoperative recurrence and prognosis in the patients with advanced colorectal cancer （CRC）.Methods The preoperative and 1 month postoperative quantitative expression of hTERT mRNA in peripheral blood in 85 patients with advanced CRC were detected with real-time fluorescence quantitative real-time fluorescence quantitative polymerase chain reaction （RTPCR）.The quantitative expression of hTERT mRNA in peripheral blood in 30 normal controls were also detected.The postoperative prognosis was followed-up,and the quantitative expression of hTERT mRNA in peripheral blood in the patients with recurred CRC and the patients without recurred CRC were detected repeatedly.The factors that affected the preoperative hTERT mRNA expression were analyzed.The relationship was investigated between the hTERT mRNA expression levels and postoperative recurrence and prognosis in the patients with advanced CRC.Results The hTERT mRNA expression levels in peripheral blood in advanced CRC group were significantly higher than those in the normal controls [（6.22 ±5.85）2-△△Ct vs （0.45 ±0.27）2-△△Ct,（P 〈0.01）],and were significantly decreased at the time point of 1 month after the operation （P 〈 0.01）.The hTERT mRNA expression levels in the postoperative recurred CRC group were significantly higher than those in the 1 month postoperation group and no recurrence CRC group [（5.07 ± 2.87）2-△△Ct vs （1.83 ± 1.08）2-△△Ct,（2.15 ± 1.49）2-△△Ct,（P 〈0.01）].Univariate analysis revealed that preoperative high hTERT mRNA expression levels in peripheral blood were related to the differentiated degree of tumor,tumor size,lymph node metastasis ratio,and liver metastasis （P 〈 0.05 or P 〈 0.01）.Multivariate logistic regression analysis revealed that differentiated degree of the tumor,lymph node metastasis,and liver metastasis were independent risk factors for the elevation of preoperative hTERT mRNA expression in the advanced CRC.Elevated preoperative hTERT mRNA expression was positively related to the postoperative recurrence rate,and was negatively related to postoperative survival rate.Conclusions Preoperative hTERT mRNA expression levels in peripheral blood were related to the important pathologic features in patients with advanced CRC,and might be a valuable prognostic factor.Postoperatively elevated hTERT mRNA expression in peripheral blood was related to recurrence of advanced CRC.