外周血循环肿瘤细胞在结直肠癌患者中的水平与病理特征的关系

Relationship between the Level of Peripheral Blood Circulating Tumor Cells in Patients with Colorectal Cancer and Pathological Characteristics

目的探讨外周血循环肿瘤细胞在结直肠癌患者中的水平与病理特征的关系。方法选取2017年6月—2019年8月间该院收治的结直肠癌患者76例,同期结直肠良性病变的患者58例。采集患者外周静脉血4 mL,阴性富集联合免疫荧光原位杂交法检测外周血循环肿瘤细胞水平,根据CD45、CEP7、CEP8的状态对外周血分离富集得到的细胞进行分型,其中CD45+细胞为白细胞;DAPI+、CD45-、CEP7或/和CEP8≥2为外周血循环肿瘤细胞。结果结直肠癌组患者外周血循环肿瘤细胞为(2.60±0.55)个/7.5 mL,明显高于良性病变组患者外周血循环肿瘤细胞(0.15±0.05)个/7.5 mL,差异有统计学意义(P<0.01)。ROC曲线分析显示,当外周血循环肿瘤细胞的Cut-off值为2个/7.5 mL时约登指数最大,诊断结直肠癌的敏感度为80.38%,特异性为88.51%。不同分化程度、淋巴结转移情况的结直肠癌患者间外周血循环肿瘤细胞≥2个/7.5 mL比例比较差异有统计学意义(P<0.01);不同T分期、N分期、M分期、外周组织侵犯情况的结直肠癌患者间外周血循环肿瘤细胞≥2个/7.5 mL比例比较差异无统计学意义(P>0.05)。结论结直肠癌患者外周血循环肿瘤细胞计数明显增加,具有较好的诊断敏感度和特异性,且与分化程度、淋巴结转移情况密切相关。

Objective To explore the relationship between the level of peripheral blood circulating tumor cells in patients with colorectal cancer and pathological characteristics.Methods 76 patients with colorectal cancer admitted in the hospital from June 2017 to August 2019 were selected,and 58 patients with benign colorectal lesions during the same period were selected.Collect 4ml of peripheral venous blood of the patient,detect the level of peripheral blood circulating tumor cells by negative enrichment combined with immunofluorescence in situ hybridization,and classify the cells obtained by separation and enrichment of peripheral blood according to the status of CD45,CEP7,CEP8;DAPI+,CD45-,CEP7 or/and CEP8≥2 are peripheral blood circulating tumor cells.Results Peripheral blood circulating tumor cells in the colorectal cancer group were(2.60±0.55)/7.5 mL,which was significantly higher than that in the benign lesion group(0.15±0.05)/7.5 mL,the difference was statistically significant(P<0.01).ROC curve analysis showed that when the Cut-off value of peripheral blood circulating tumor cells was 2/7.5 mL,the Youden index was the largest,the sensitivity for diagnosis of colorectal cancer was 80.38%,and the specificity was 88.51%.There were statistically significant differences in the proportion of peripheral blood circulating tumor cells≥2/7.5 mL among colorectal cancer patients with different degrees of differentiation and lymph node metastasis(P<0.01);different T stage,N stage,M stage,peripheral tissue invasion had no statistically significant difference in the proportion of peripheral blood circulating tumor cells≥2/7.5 mL among colorectal cancer patients(P>0.05).Conclusion The number of circulating tumor cells in peripheral blood of patients with colorectal cancer is significantly increased,which has good diagnostic sensitivity and specificity,and is closely related to the degree of differentiation and lymph node metastasis.