481例恶性肿瘤患者循环肿瘤细胞(CTC)检测的回顾性分析

A retrospective analysis of circulating tumor cells(CTCs) in 481 patients with malignant tumor

目的基于CellSearch平台,回顾性分析肝癌、胃癌、结直肠癌、乳腺癌、胰腺癌、肺癌、前列腺癌7类肿瘤患者循环肿瘤细胞(circulating tumor cell,CTC)数量及形态特征,探讨其临床价值。方法回顾分析复旦大学附属中山医院检验科2014年12月至2016年4月7类肿瘤患者共481例CTC检测结果,有CTC检出者回顾原始荧光检测图像,随访时间更新至2018年4月。比较7类肿瘤患者术前、术后CTC数量变化及形态特征。分析肝癌患者不同治疗阶段的CTC形态变化及其临床价值。结果术前组CTC检出率为53%～100%,术后组为0～37%,7类肿瘤术后组均有显著下降,其中乳腺癌和胃癌下降最为显著(χ2=9.12,P=0.003;χ2=5.76,P=0.016)。不同肿瘤CTC形态存在较大异质性,以肝癌和肺癌为甚。肝癌患者连续监测结果显示,不同治疗阶段的CTC数量及形态均有变化且与临床预后相关。结论 7类肿瘤术后组CTC7.5检出率显著低于术前组。在肝癌治疗监测过程中,CTC形态变化对于治疗反应及临床预后可能有一定的提示作用。

Objective Based on the CellSearch platform,the number and morphology of circulating tumor cells(CTCs)in 7 different types of cancer including liver cancer,gastric cancer,colorectal cancer,breast cancer,pancreatic cancer,lung cancer and prostate cancer were analyzed retrospectively to explore their clinical value. Methods The CTCs test results of 481 cases in patients with 7 different types of cancer from the Department of Clinical Medicine,Zhongshan Hospital,Fudan University during Dec.,2014 and Apr.,2016 were retrospectively reviewed.The original fluorescence detection images were reviewed in patients with detectable CTCs.The follow-up time was updated to Apr.,2018.The differences in number and morphological characteristics of CTCs in 7 types of cancer were compared between preoperative and postoperative groups.The morphological changes of CTCs and clinical value in different treatment stages were analyzed in liver cancer. Results Dectable rate of CTCs in7 types of cancer was 53%-100%in the preoperative group and0-37%in the postoperative group.The rates in postoperative groups were significantly decreased,of which breast cancer and gastric cancer ranked top two(χ2=9.12,P =0.003;χ2=5.76,P =0.016).Morphological heterogeneity among CTCs of different cancers was significant,especially in liver cancer and lung cancer.Continuous monitoring results in liver cancer patients showed that the number and morphology of CTCs in different treatment stages both changed,and they were linked to clinical prognosis.Conclusions The detection rate of CTC7.5 in the postoperative group of 7 different types of cancer was significantly lower than that of the preoperative group.In the course of treatment monitoring of liver cancer,changes in the morphology of CTCs may play a certain role in the treatment response and clinical prognosis.