乳腺癌CTC与病理特征及预后相关性分析

目的通过对可手术乳腺癌患者外周血中循环肿瘤细胞(CTC)的检测,探讨乳腺癌患者外周血CTC在评估病情和预后评估中的价值。方法收集2016年1~5月期间就诊的68例乳腺癌患者,采用免疫磁珠阴性富集CTC,免疫荧光原位杂交技术(FISH)鉴定CTC。比较CTC检测结果与患者年龄、肿瘤直径、TNM分期、HER-2、乳腺癌分子分型的相关性。比较乳腺癌患者化疗前后CTC检测情况。从第一次诊疗后开始随访,以电话形式每隔3个月随访1次,共随访4年,计算并比较CTC阳性患者与阴性患者的生存率。结果免疫磁珠阴性富集法成功进行了乳腺癌CTC的鉴定,鉴定出CTC阳性患者24例,阴性患者44例。CTC阳性率与肿瘤直径显著相关(P<0.05),肿瘤直径>5cm的患者比直径<5cm患者更易检测出CTCs阳性。乳腺癌患者CTC阳性率与肿瘤TNM分期显著相关(P<0.05),TNM分期为Ⅰ期CTCs阳性率为16.7%,Ⅲ期为45.8%,差异有统计学意义(P<0.05)。不同年龄、不同乳腺癌分子分型及HER-2表达与CTCs阳性无显著相关性(P>0.05)。化疗前乳腺癌患者中CTC阳性率为35.3%(24/68),化疗后CTC阳性率显著下降为19.1%(13/68),差异有统计学意义(P<0.05)生存分析结果提示CTC阳性患者总生存率为37.12%,CTC阴性患者总生存率为60.12%,差异有统计学意义(P<0.05)。结论乳腺癌患者外周血CTC阳性率与肿瘤直径大小和TNM分期有相关性,CTC可用于评估乳腺癌患者预后,化疗后CTC变化与化疗疗效有一定关系。

Objective To investigate the value of circulating tumor cells(CTC)in evaluating the condition and prognosis of patients with breast cancer by detection of CTC in peripheral blood of patients with breast cancer.Methods A total of 68 patients with breast cancer were enrolled in our hospital from January 2016 to May 2016.CTC was determined by immunofluorescence in situ hybridization(FISH)with negative enrichment of CTC by immunomagnetic beads.The correlation between CTC and patients'age,tumor diameter,TNM stage,HER-2 and breast cancer molecular typing were compared.CTC detection in breast cancer patients before and after chemotherapy was compared.Follow-up was conducted after the first treatment for every 3 months by telephone for 4 years.Survival rates of CTC-positive and CTC-negative patients were calculated and compared.Results CTC of breast cancer was successfully identified by immunomagnetic bead negative enrichment method,and 24 patients with positive CTC and 44 patients with negative CTC were identifed.The CTC positive rate was significantly correlated with tumor diameter(P<0.05).Patients with tumor diameter greater than 5cm were more likely to detect CTCs positive than patients with tumor diameter less than 5cm.Breast cancer CTC positive rate were significantly associated with tumor TNM staging(P<0.05),TNM stage for Ⅰ CTCs positive rate was 16.7%,Ⅲ period was 45.8%,the difference was statistically significant(P<0.05).There was no significant correlation between different ages,different breast cancer molecular typing and HER-2 expression and CTCs positive(P>0.05).Before chemotherapy,the positive rate of CTC in breast cancer patients was 35.3%(24/68),and after chemotherapy,the positive rate of CTC signifcantly decreased to 19.1%(13/68),showing a statistical difference(P<0.05).The survival analysis results indicated that the overall survival rate of ctc-positive patients was 37.12%,and that of CTC-negative patients was 60.12%(P<0.05).Conclusion The positive CTC rate in peripheral blood of breast cancer patients is correlated with tumor diameter and TNM.CTC can be used to evaluate the prognosis and survival rate of breast cancer patients.The change of CTC after chemotherapy has a certain relationship with the eficacy of chemotherapy.