肿瘤源性血管内皮生长因子A促进鼻咽癌肺转移的实验研究

Tumor-secreted vascular endothelial growth factor A increases the pulmonary metastasis from nasopharyngeal carcinoma

目的通过对循环肿瘤细胞（circulating tumor cell，CTC）的检测，探讨其在头颈部鳞状细胞癌（squamous cell carcinoma of the head and neck, HNSCC）中的意义。方法收集2016年10月至2017年7月南京同仁医院耳鼻咽喉头颈外科就诊的HNSCC病例，纳入24例作为试验组，其中男23例，女1例；年龄45～82岁；喉癌14例，下咽癌10例；TNM分期Ⅰ-Ⅱ期5例，Ⅲ-Ⅳ期19例；高分化鳞癌8例，中低分化鳞癌16例。所有24例均为初发和/或治疗后复发的HNSCC患者，均无并发其他部位的恶性肿瘤。纳入9名健康志愿者作为对照组。CTC检测利用一种新型的体内检测系统——CellCollector系统进行，治疗前对24例患者均进行了CTC检测，治疗后对16例患者进行18次检测，此16例患者最终均行手术治疗，对手术患者均在术后1周进行再次检测。其中对19例阳性CTC进行了EGFRvⅢ检测，2例阳性CTC进行了基因突变检测。利用SPSS 23.0软件对结果进行回顾性分析。结果①治疗前总捕获率70.8%（17/24），其中Ⅰ-Ⅱ期捕获率40%（2/5），Ⅲ-Ⅳ期捕获率78.9%（15/19）；手术后总捕获率50%（8/16）。对照组捕获率0。②CTC与患者年龄、性别、肿瘤位置、是否有淋巴结转移均无明显相关（P〉0.05）。与肿瘤分期、肿瘤分化程度相关，差异有统计学意义（P〈0.05）。③ CTC中EGFRVⅢ阳性率为26.3% （5/19）；基因突变检测发现TP53、RB1、PIK3CA等基因突变。结论CellCollector系统是检测CTC的一种非常高效的方式，CTC在HNSCC的发生、进展和转移中有重要的意义，通过对CTC的进一步研究，为HNSCC的早期发现、疗效检测、预后评估等方面提供依据。

ObjectiveTo investigate the significance of circulating tumor cells （CTC） in squamous cell carcinoma of the head and neck （HNSCC）.MethodsTwenty-four patients with HNSCC treated between October 2016 and July 2017 in our department were selected （experimental group）, including 23 males and 1 females, aged 47-81 years. There were 14 cases of squamous cell carcinoma of larynx and 10 cases of hypopharynx, including I-Ⅱ stage （5 cases） and Ⅲ- Ⅳ stage （19 cases）. All patients were primary and/or relapsed after treatment. Nine healthy volunteers were selected as control group. A novel in vivo capture technique （CellCellector system） was used to detect CTC. SPSS23.0 was used for statistical analysis.ResultsThe total capture rate of CTC in patients with HNSCC before treatment was 70.8% （17/24）, with 40% （2/5） for patients at I-Ⅱ stage, and 78.9% （15/19） for patients at Ⅲ- Ⅳ stage, and was 0 in patients of control group. The total capture rate of CTC in patients with HNSCC after treatment was 50% （8/16）. There was no significant correlation between CTC and age, sex, location of tumor or lymph node metastasis （P〉0.05）. CTC was related to tumor staging and tumor differentiation （P〈0.05）. The positive rate of EGFRVⅢ in CTC was 26.3% （5/19）.ConclusionsThe CellCollector system is a very efficient way of detecting CTC, and CTC plays an important role in the occurrence, progression and metastasis of HNSCC.