甲状腺癌外周血细胞角蛋白19和多态性上皮黏蛋白联合检测的临床意义

Clinical value of combined detection of cytokeratin 19 and polymorphic epithelial mucin in peripheral blood of patients with thyroid cancer

目的 :检测甲状腺癌患者外周血细胞角蛋白19(cytokeratin 19,CK19)和多态性上皮黏蛋白(polymorphic epithelial mucin,MUC1)的表达以及作为外周血循环肿瘤细胞和血行微转移检测标志物的应用价值。方法 :采用流式细胞术,检测491例甲状腺癌患者以及376例结节性甲状腺肿患者外周血中CK19和MUC1阳性表达的细胞。结果 :甲状腺癌患者和结节性甲状腺肿患者的外周血CK19阳性表达率分别为35.4%(174/491)和7.7%(29/376),差异有统计学意义(P=0.000);外周血MUC1阳性表达率分别为32.8%(161/491)和3.5%(13/376),差异也有统计学意义(P=0.000)。单因素分析结果显示,肿瘤大小、包膜侵犯、淋巴结分期和远处转移均与甲状腺癌外周血CK19或MUC1阳性表达以及甲状腺癌外周血CK19和MUC1均为阳性表达显著相关(P<0.05)。多因素分析结果显示,甲状腺癌包膜侵犯、淋巴结分期和远处转移均是甲状腺癌外周血CK19阳性表达、MUC1阳性表达以及CK19和MUC1均为阳性表达的独立影响因素(P<0.05)。CK19阳性表达与MUC1阳性表达之间呈显著正相关(r=0.628,P=0.000)。结论 :甲状腺癌外周血CK19和MUC1阳性表达与甲状腺癌包膜侵犯、淋巴结分期和远处转移均密切相关,外周血CK19和MUC1检测有助于甲状腺癌血行微转移的预测及预后评估。

Objective： To examine the expressions of cytokeratin 19（CK19） and polymorphic epithelial mucin（MUC1） in peripheral blood of patients with thyroid cancer, and evaluate their clinical value as the biomarkers in the detection of circulating tumor cells and blood micrometastasis. Methods： The fl ow cytometry（FCM） was used to detect CK19-positive and MUC1-positive cells in peripheral blood of 491 patients with thyroid cancer and 376 patients with nodular goiter. Results： The positive expression rates of CK19 in patients with thyroid cancer and nodular goiter were 35.4%（174/491） and 7.7%（29/376）, respectively（P = 0.000）; the positive expression rates of MUC1 in patients with thyroid cancer and nodular goiter were 32.8%（161/491） and 3.5%（13/376）, respectively（P = 0.000）. In univariate analysis, the tumor size, tumor capsule invasion, lymph node metastasis and distant metastasis were signifi cantly associated with the positive expression of CK19 or MUC1 and the positive expressions of both CK19 and MUC1（P 〈 0.05）. In multivariate analysis, tumor capsule invasion, lymph node metastasis and distant metastasis were independent factors related to the positive expression of CK19 or MUC1 and the positive expressions of both CK19 and MUC1（P 〈 0.05）. There was a positive correlation between the expressions of CK19 and MUC1（r = 0.628, P = 0.000）. Conclusion： The expressions of CK19 and MUC1 were signifi cantly related to tumor capsule invasion, lymph node metastasis and distant metastasis of thyroid cancer, and these two biomarkers may be helpful to predict the blood micrometastasis and evaluate the prognosis.