围手术期血循环中肺癌细胞与预后的关系

Perioperative Detection of Circulating Lung Cancer Cells in the Blood and its Prognostic Significance

[目的]分析可手术性非小细胞肺癌 (NSCLC)患者术前和术中癌细胞血道播散及其对患者预后的影响。[方法]术前或术中采集外周血或肺静脉血 ,应用流式细胞仪进行癌细胞定量测定。患者于手术后定期随访 ,并与检测结果作统计学分析。[结果]对44例NSCLC患者血样进行了检测 ,共发现16例存在癌细胞 ,阳性率为36.4 % ,癌细胞平均含量为0.286×106/L。其中60岁以下年龄组的癌细胞阳性率显著高于60岁以上年龄组(P<0.05) ,鳞癌患者的癌细胞含量显著高于腺癌患者 (P<0.05)。但25%的腺癌患者在术前已出现癌细胞播散 ,术中阳性率为42.9%,癌细胞阳性率与病期无明显相关性 ;鳞癌患者术前未发现阳性病例 ,术中阳性率为57.1% ,阳性者以Ⅲ、Ⅳ期为主。随访结果显示 ,血循环癌细胞阳性和阴性组的中位生存期分别为15个月和>30个月 ,2年生存率分别为31.3%和71.4 % ,具有统计学显著差异 (P<0.05)。[结论]肺癌患者在手术前或手术过程中可发现血液中存在癌细胞 ,此类患者的预后差、生存期短。

To analyze the circulating cancer cells in the blood before and during surgical resection in patients with operable non-small cell lung cancer (NSCLC) and to evaluate its prognostic significance.Samples from peripheral blood or pulmonary venous were obtained before and during surgical resection. Blood samples were analyzed by flow cytometry for detection of circulating cancer cells. The survival was followed_up for 30 months and their relationship was evaluated statistically.Of the 44 patients with NSCLC analyzed, sixteen had cancer cells in their blood, with the positive rate of 36.4%. The average amounts of cancer cells in these cases were 0.286×10 6/L. The positive rate in younger patients(<60 years_old) and patients with squamous histology was significantly higher than those in the older group and patients with adenocarcinoma, respectively (P<0.05). Moreover, 25% of patients with adenocarcinoma was positive for cancer cells before surgery. During the operation, a positive rate of 42.9% was found in this group. This rate was independent on the stages of disease. In contrast, no positive case was detected in patients with squamous cell carcinoma before surgery. The positive rate in this group during operation was 57.1%, among which a higher frequency of positive test results was found in patients at stage Ⅲ and Ⅳ. On the basis of 30 months follow_up, the media survival for the positive and negative groups was 15 months and more than 30 months, respectively. The 2_year survival rate was 31.3% for the positive group and 71.4% for the negative group. These differences were statistically significant (P<0.05).[Conclusion]Circulating cancer cells in the blood can be detected in NSCLC patients before and during surgery. These patients had a significantly shorter overall survival and poor prognosis.