循环肿瘤细胞监测在结直肠癌肝转移微波消融治疗中临床价值的评估

Monitoring of circulating tumor cells in patients with liver metastases from colorectal cancer undergoing microwave ablation

目的探讨利用循环肿瘤细胞(CTCs)评估结直肠癌肝转移微波消融治疗的疗效及其与预后的关系。方法收集2014年1月至2018年5月在南京市第二医院因结直肠癌肝转移行肝脏病灶微波消融治疗的29例患者的临床资料,并纳入术前与术后CTCs检测结果。计数资料分析采用χ~2检验或Fisher确切概率法;生存分析采用Kaplan-Meier法和Logrank检验。结果经影像学评估,29例患者局部病灶微波消融的近期疗效为完全消融者8例、部分消融16例和进展5例。29例患者微波消融术后CTCs测量值较术前升高,差异有统计学意义(Z=-2. 489,P=0. 013);患者的年龄、性别、术后CTCs升高与否、结直肠癌原发部位、同时性或异时性肝转移与微波消融近期疗效均无关(P>0. 05)。微波消融术后CTCs数目<7个/ml患者局部肝转移病灶的近期疗效优于术后CTCs数目≥7个/ml者(P=0. 031)。29例患者的中位生存时间(OS)为30. 0个月(95%CI:10. 7～49. 3个月)。入组患者的年龄、结直肠癌原发部位及肝转移后的治疗方式与中位OS相关(P<0. 05),而性别、同时性或异时性肝转移、术后CTCs升高与否及术后CTCs值/ml与中位OS均无关(P>0. 05)。结论微波消融是结直肠癌肝转移局部治疗的有效手段,治疗前后CTCs数量的监测可能有助于评估其近期疗效。

Objective To investigate the clinical value of circulating tumor cells(CTCs)in evaluating the prognostic value in patients with metastatic colorectal cancer undergoing microwave ablation.Methods A total of 29 patients who received microwave ablation for hepatic metastases from colorectal cancer at the Second Hospital of Nanjing from January 2014 to May 2018 were enrolled in this study.Preoperative and postoperative blood samples from these patients were tested for CTCs.CTCs values and clinical data of the 29 cases were analyed.The data was analyzed by Chi square test or Fisher exact test,and the survival analysis was performed by Kaplan-Meier method and Log-rank test.Results The short-term efficacy of microwave ablation for local lesions in 29 patients was assessed by imaging.The short-term outcome was complete ablation in 8 patients,partial ablation in 16 patients and progressive ablation in 5 patients.An increase in CTCs values after microwave ablation was found(Z=-2.489,P=0.013).While,age,sex,synchronous colorectal liver metastasis or not,left or right colorectal cancer and the change of CTC values after microwave ablation were no statistically significant(P>0.05).The short-term effect of local liver metastases in patients with CTCs<7/ml after microwave ablation was better than that in patients with CTCs≥7/ml,and the difference was statistically significant(P=0.031).The median overall survival(OS)of 29 patients was 30.0 months(95%CI:10.7-49.3 months).The median OS of patients under 60 years old were better than those aged 60 and above(P=0.008).The median OS in patients with left colon cancer was better than that in patients with right colon cancer(P=0.028).The patients with microwave ablation only have worse survival than combined treatment(P=0.001).But gender,simultaneous or heterogeneous liver metastasis,elevated CTCs and postoperative CTCs/ml were not associated with median OS(P>0.05).Conclusion Microwave ablation is an effective method for local treatment of colorectal cancer with liver metastases.Monitoring the number of CTCs before and after treatment may be helpful to evaluate the short-term curative effects.