膀胱癌根治性膀胱全切患者外周血循环肿瘤细胞与凝血及临床病理指标的相关性

Relationship of circulating tumor cell status with coagulation and clinicopathological variables in patients with bladder cancer treated with radical cystectomy

目的 探讨膀胱癌根治性膀胱全切患者循环肿瘤细胞(CTC)与血浆D-二聚体(D-D)、纤维蛋白原(FIB)、血小板(PLT)等凝血评估指标和临床病理指标的相关性。方法 选取在郑州大学第一附属医院行根治性膀胱全切术的肌层浸润性膀胱癌患者85例,采集其术前血样,检测其CTC计数和凝血指标,并收集其临床和病理学资料,记录术后90 d随访期内静脉血栓栓塞症(VTE)的发生。按照CTC计数分为CTC阴性组(CTC=0,58例)和阳性组(CTC≥1,27例)。分析CTC计数与凝血指标和临床病理指标的相关性。结果 术后随访期内在CTC阳性组发生4例VTE(4.7%);与CTC阴性组比较,血浆D-D在CTC阳性组中表达显著增高(P<0.05),但FIB和PLT在两组间差异无统计学意义(P>0.05);临床病理指标TNM分期、性别、年龄、ECOG评分在两组间差异无统计学意义(P>0.05);但切缘阳性和局部淋巴结转移在两组间差异有统计学意义(P<0.05);而血浆D-D和切缘阳性是CTC计数阳性的独立预测因素。结论 CTC计数阳性患者有潜在发生VTE的风险,而且有较高的血浆D-D水平、切缘阳性率和局部淋巴结转移率。

Objective To investigate the relationship between circulating tumor cell (CTC) counts with plasma D-dimer (D-D), fibrinogen (FIB), platelet (PLT) and clinicopathological features in patients with bladder cancer treated with radical cystectomy.Methods The CTC counts, coagulation indexes and clinicopathological data in 85 cases of muscle invasive bladder cancer undergoing radical cystectomy were analyzed. The occurrence of venous thromboembolism (VTE) during the follow-up period (90 days) was recorded. According to the CTC counts, patients were divided into two groups: CTC negative group (CTC=0, n=58) and CTC positive group (CTC≥1, n=27). The relationship of CTC counts with coagulation indexes and clinicopathological variables was analyzed.Results There were 4 cases of postoperative VTE in CTC positive group (4.7%) during the follow-up period. The D-D level in CTC positive group was significantly higher than in CTC negative group (P<0.05), and there was no significant difference in FIB and PLT between two groups. There was no significant difference in TNM stage, age, gender and ECOG scores between two groups. The surgical margin positive rate and incidence of local lymph node metastasis in CTC positive group were significantly higher than in CTC negative group (P<0.05). Plasma D-D levels and positive surgical margin were the independent predictive factors for positive CTC counts.Conclusion Presence of CTC may be associated with VTE. CTC positive group has higher D-D level, positive surgical margin and local lymph node metastasis.