全胸腔镜下根治术与胸腔镜辅助小切口术对NSCLC患者外周血CTC细胞数量变化的影响

The Effect of Total Thoracoscopic Radical Resection and Thoracoscope-assisted Small Incision Surgery on the CTC Number of Peripheral Blood in Patients with NSCLC and Its Correlation with Prognosis

目的探讨全胸腔镜下根治术与胸腔镜辅助小切口术对非小细胞肺癌(NSCLC)患者外周血循环肿瘤细胞(CTC)数量变化的影响及其与预后的关系。方法选取四川省医学科学院·四川省人民医院2016年1月至12月收治的50例NSCLC患者为研究对象,按就诊时间分为全胸腔镜组与小切口组各25例。全胸腔镜组采用全胸腔镜下根治术,小切口组采用胸腔镜辅助小切口术。比较两组术中与术后指标,统计术后并发症发生率,对患者进行为期2年随访,统计肿瘤复发与转移发生率。于术前2d与术后2d检测患者外周血CTC细胞数量,分析外周血CTC细胞数量与肿瘤复发转移的关系。结果全胸腔镜组与小切口组术后2d外周血CTC细胞数量分别为[19(0,40)]个/5mL、[17(0,39)]个/5mL,与术前2d的[13(0,28)]个/5mL、[12(0,25)]个/5mL比较差异有统计学意义(P<0.05)。在为期2年随访中共出现11例肿瘤复发,4例远处转移,两组肿瘤复发率与转移率比较差异无统计学意义(P>0.05)。NSCLC患者术后2d外周血CTC细胞数量与随访2年内肿瘤复发转移呈正相关(rs=0.529,P<0.05)。结论 NSCLC患者全胸腔镜下根治术与胸腔镜辅助小切口术后外周血CTC细胞数量均明显增多,外周血CTC细胞数量与肿瘤复发转移呈正相关,外周血CTC细胞数量可作为NSCLC患者预后预测因子。

Objective To study the effect of total thoracoscopic radical resection and thoracoscope-assisted small incision surgery on the number of peripheral blood circulating tumor cells(CTC)in patients with non-small cell lung cancer(NSCLC)and its correlation with the prognosis.Methods 50 NSCLC patients treated from January to December of 2016 in Sichuan Provincial People's Hospital were selected as the subjects.Those patients were divided into the total thoracoscopic group and small incision group according to the time of treatment and each group included 25 cases.The total thoracoscopic group was treated with total thoracoscopic radical resection,while the small incision group was treated with thoracoscope-assisted small incision surgery.The intraoperative and postoperative indexes were compared between the two groups and the incidence of complications was statistically analyzed.Those patients were followed up for 2 years and the incidence of tumor recurrence and metastasis were statistically analyzed.The CTC number of peripheral blood was detected 2 days before and after operation respectively and the correlation between the CTC number of peripheral blood and the tumor recurrence and metastasis was analyzed.Results The CTC numbers of peripheral blood 2 days after operation were 19(0,40)/5ml in the total thoracoscopic group and 17(0,39)/5ml in the small incision group and they were significantly different from those 2 days before operation which were 13(0,28)/5ml in the total thoracoscopic group and 12(0,25)/5ml in the small incision group(P<0.05).There were 11 cases with tumor recurrence and 4 cases with distant metastasis during 2 years of follow-ups,and there no significant differences between the two groups(P>0.05).The CTC number of peripheral blood 2 days after operation in NSCLC patients was positively correlated with the tumor recurrence and metastasis within 2 years of follow-ups(r s=0.529,P<0.05).Conclusion The CTC number of peripheral blood is significantly increased after total thoracoscopic radical resection and thoracoscope-assisted small incision surgery in patients with NSCLC,and it is positively correlated with the tumor recurrence and metastasis.Therefore,the CTC number of peripheral blood can be used as a prognostic predictive factor in patients with NSCLC.