胰腺癌患者外周血循环肿瘤细胞与其术后复发及预后的关系

The relationship of circulating tumor cells in peripheral blood of pancreatic cancer patients with postoperative recurrence and prognosis

目的采用新型纳米微流控芯片检测胰腺癌患者外周血循环肿瘤细胞（CTCs），探讨其与胰腺癌病理参数及患者术后复发、预后的关系。方法收集2015年1月至2017年1月问嘉兴医学院附属第二医院收治的53例胰腺癌手术切除患者的外周血，应用新型纳米微流控芯片检测CTCs，以检测到1个CTC为阳性标准将患者分为CTCs阳性组和阴性组，评估CTCs阳性与肿瘤临床病理参数及患者术后复发、预后的关系。结果53例患者中23例外周血CTCs阳性细胞数为5-196个／ml，平均（78．5±44．7）个／ml，阳性率为43．4％（23／53）。CTCs阳性与肿瘤血管侵犯显著相关（P=0．001），而与患者性别、年龄、有无临床症状、肿瘤直径、病理类型、淋巴结转移、TNM分期均无相关性。31例肿瘤复发，复发率为58．5％。其中局部复发13例，远处转移（包括肝、肺、肾等）10例，局部复发并远处转移8例。患者无瘤中位生存时间14．0个月（13．0-17．0个月），总体中位生存时间19．0个月（15．5-24．0个月）。CTCs阳性组、阴性组1年无瘤生存率分别为66．9％、88．3％，2年无瘤生存率分别为12．2％、42．2％，差异均有统计学意义（P值均〈0．05）；1年总生存率分别为85．4％、96．3％，2年总生存率分别为33．6％、62．2％，其中2年总生存率的差异有统计学意义（P=0．028）。结论采用新型纳米微流控芯片能够高效检测出胰腺癌患者外周血CTCs，CTCs阳性与胰腺癌血管侵犯、患者术后生存时间密切相关，可作为判断胰腺癌患者术后复发和预后的一个重要指标。

Objective To detect circulating tumor cells （CTCs） in the peripheral blood of patients with pancreatic cancer using a new nano microfluidic chip and to explore the relationship between CTCs and clinicopathological feature, postoperative recurrence and prognosis of pancreatic cancer. Methods The peripheral blood samples of 53 patients with pancreatic cancer who underwent curative resection in the second affiliated hospital of Jiaxing college of medicine were collected from January 2015 to January 2017. The CTCs from peripheral blood were detected by novel nano microfluidic chip. The cut-off value for CTCs-positive and negative groups was 1 CTC. The relationship between CTCs positive and postoperative recurrence and prognosis of pancreatic cancer were evaluated. Results The number of CTCs for 23 panerealic cancer of 53 patients ranged from 5 to 196 per ml, and the mean number was 78.5 ± 44.7 per ml ; the rate of CTCs-positive patients was 43.4% （ 23/53 ）. There were significant correlation between CTCs with vascular invasion （ P = 0.001 ）, but but CTCs was not correlated with the gender, age, the presence of clinical symptoms, tumor size, pathological type, lymph metastasis and TNM stage. 31 patients had tumor recurrence, and the rate of tumor recurrence was 58.5%. Among them, there were 13 eases with tumor local recurrence, 10 c.ases with tumor distant metastasis （ including liver, hmg, kidney, etc. ） and 8 cases with both tumor local recurrence and distant metastasis. The median recurrence free survival time of all patients was 14.0 months （ 13.0 - 17.0） and the median overall survival time was 19.0 months （15.5 -24.0）. The cumulative one-year and two-year reemTenee free survival rate were 66.9%, 12.2% for patients with CTCs-positive and 88.3%, 42.2% tot CTCs-negative patients, and the differences were statistically significant （ both P 〈 0.05 ）. The cumulative one-year and two-year overall survival rate were 85.4% , 33.6% for patients with CTCs-positive and 96.3% , 62.2% fbr CTCs-negative. There was no difference in statistics in cumulative one-year overall survival rate and with a statistieally significant differenee in cumulative two-year overall survival rate （ P = 0.028）. Conclusions Peripheral blood CTCs of pancreatic cancer can be effectively detected by a novel nano mierofluidic ehip. There were significant eorrelatiou between CTCs with vaseular invasion and survival time after surgery. CTCs may be a potential prognostic indicator of the postoperative recurrence and prognosis of panereatie eaneer.