晚期非小细胞肺癌循环肿瘤细胞特征性的初步探究

Initial researches on the characteristics of circulating tumor cells in advanced non-small cell lung cancer

目的探讨循环肿瘤细胞(CTCs)数目及分型在晚期非小细胞肺癌(NSCLC)患者疾病特征中的差异性表现。方法根据纳入和排除标准入组29例晚期肺腺癌及腺鳞癌患者,并收集患者的一般资料(年龄、性别、吸烟、肿瘤家族史)和疾病状态(病理分型、肿块位置、TNM分期、T分期、M分期、N分期及器官转移状况);应用Canpatrol^(TM)CTC富集平台计数外周血CTCs数目,并依据上皮和间质标记物的表达将CTCs分为上皮、混合及间质3种亚型。在CTCs检测的1个月内行胸部CT、骨扫描、头颅核磁共振、腹部超声或全身PET/CT检查。对上述数据行Mann-Whitney U或Kruskal-Wallis H非参数检验。结果29例患者中,25例检测出CTCs,CTCs以混合型为主,其中19例发生骨转移,椎骨转移发生最多。初治与复治患者的总CTCs及混合型CTCs的差异均有统计学意义(P<0.05)。上皮型CTCs在年龄、TNM分期、M分期、N分期及有无肺外转移、骨转移、椎骨转移的差异均有统计学意义(P<0.05);间质型CTCs在有无胸腔积液中的差异有统计学意义(P<0.05)。结论晚期NSCLC以混合型CTCs多见,上皮型CTCs与晚期肺癌分期、M分期呈正相关并与骨转移的发生密切相关,骨是肺外CTCs最常定植的器官。

Objective To explore the significance of the quantity and phenotype of the circulating tumor cells（ CTCs） to the disease characteristics of non-small cell lung cancer. Methods Twenty-nine advanced lung adenocarcinomas and adenosquamous car-cinoma patients were enrolled in this clinical trial. General information and disease status was collected. The former contained the char-acteristics of age, gender, whether smoking and family history of cancer, and the latter included the characteristics of pathological type, lump location, TNM stage, T stage, N stage, M stage and the metastases in different organs. CanpatrolTM CTC was applied to count the number of CTCs, and the CTCs were divided into three subtypes including epithelial CTCs, biphenotypic CTCs, mesenchymal CTCs. Meanwhile the patients should be checked by computed tomograhy, bone scanning, brain MRI, abdominal ultra-sonography and positron emission computed tomography within one month. Mann-Whitney U test or Kruskal-Wallis H test was conducted to analyze the data, and the statistical significance was performed. Results Twenty-five patients were detected with CTCs most of which were biphenotypic CTCs. Among the 25 patients, 19 patients were found with bone metastases which were the most com-mon organ that occurring metastases. The total CTCs and biphenotypic CTCs were performed with statistical significance in initial-to-re-lapse patients（ P〈0. 05） . The enumeration of epithelial CTCs were performed with statistical significance in age, TNM stage, M stage, N stage, extrapulmonary metastases, bone metastases and vertebra metastasis（ P〈0. 05） . The mesenchymal CTCs were showed statisti-cal significance in the appearance of medium-large pleural effusion（P〈0. 05）. Conclusion The biphenotypic CTCs were the most common type in late stage of NSCLC. The epithelial CTCs have positive correlation with the TNM stage of advanced lung cancer, M stage and bone metastases. Bone is the most common organ that CTCs is apt to home.