循环肿瘤细胞在前列腺癌诊断中的价值

Diagnostic and therapeutic value of circulating tumor cells in prostate cancer

目的探讨循环肿瘤细胞(CTCs)在前列腺癌患者诊断中的临床应用价值。方法选择2016年9月至2019年9月于郑州大学第二附属医院泌尿外科治疗的78例前列腺癌患者为研究组和35例健康体检者为对照组,113例研究对象均采集静脉血7.5 mL,采用CanPatrolTM技术富集、分离鉴定并计数CTCs。根据CTCs计数,将前列腺癌患者分为CTCs阳性组与CTCs阴性组,同时记录其年龄、血常规、生化指标、前列腺特异抗原(PSA)、Gleason评分及病理分期等结果,分析CTCs数目与上述指标的相关性,利用四格表评价术前PSA水平、CTCs水平对前列腺癌的诊断价值。结果前列腺癌患者发生转移者CTCs阳性率显著高于未发生转移者(P<0.05);四格表预测CTCs、PSA对前列腺癌的诊断灵敏度分别为88.46%、85.89%,特异度分别为74.28%、65.71%,准确率分别为为84.07%、79.64%;前列腺癌患者CTCs阳性组HB、ALB水平明显低于CTCs阴性组(P<0.05),PLT、FIB、D-D、AKP、LDH水平明显高于CTCs阴性组(P<0.05);Pearson法结果显示,CTCs与PSA、Gleason评分均呈显著正相关关系(r=0.601,P<0.05;r=0.316,P<0.05);患者PSA水平随分期恶化程度加重而增加;CTCs个数亦随病理分期恶化程度加重而增加。结论CTCs水平与肿瘤的发生及转移、相关血清学指标、前列腺癌Gleason评分以及肿瘤病理分期具有相关性,对预测前列腺的发生发展有一定的临床意义。

Objective To investigate the clinical value of circulating tumor cells(CTCs)in the diagnosis and treatment of prostate cancer patients.Methods From September 2016 to September 2019,78 patients with prostate cancer who were treated in the urology department of the Second Affiliated Hospital of Zhengzhou University were selected as the research group and 35 healthy subjects were used as the control group.The amount of 7.5 mL venous blood was collected from each subject of both groups.CanPatrolTM technology was used to enrich,isolate,and count CTCs.According to CTCs count,prostate cancer patients were sub⁃divided into CTCs positive group and CTCs negative group,and their age,blood routine,biochemical indicators,prostate specific antigen(PSA),abdominal CT,prostate nuclear magnetic resonance(MRI),bone scan,Gleason were recorded at the same time.The correlations between the above indicators and the number of CTCs were analyzed.The diagnostic value of PSA level and CTCs level in prostate cancer was evaluated by the four⁃grid.Results The positive rate of CTCs in the patients with metastatic prostate cancer was significantly higher than that in the patients without metastasis(P<0.05).The diagnostic sensitivity of CTCs and PSA for prostate cancer was 88.46%and 85.89%,respectively,the specificity was 74.28%and 65.71%,respectively,and the accuracy was 84.07%and 79.64%,respectively.The levels of HB and ALB in the CTCs⁃positive group were significantly lower than those in the CTCs⁃negative group(P<0.05),and the levels of PLT,FIB,DD,AKP,and LDH were significantly higher than those in CTCs⁃negative group(P<0.05).Pearson analysis showed that the CTCs were significantly positively correlated with PSA and Gleason scores(r=0.601,P<0.05;r=0.316,P<0.05).The PSA levels increased with the worsening stages,with significant differences at stageⅡ,stageⅢ,stageⅣas compared with stage I,and between stageⅣand stageⅡ(P<0.05).The number of CTCs also increased with the worsening pathological stages,with statistical differences between stageⅣand stageⅡ(P<0.05).Conclusion The CTCs levels are correlated with tumorigenesis and metastasis,related serological indicators,Gleason score of prostate cancer,and tumor pathological stage,and they are of clinical significance in predicting the development of prostate cancer.