胃癌循环肿瘤细胞和循环肿瘤血管内皮细胞的检测及其临床意义

Detection and clinical significance of circulating tumor cells and circulating tumor vascular endothelial cells in gastric cancer

目的分析术前循环肿瘤细胞(CTC)和循环肿瘤血管内皮细胞(CTEC)检测在胃癌辅助诊断中的作用及其与胃癌患者临床病理特征的关系。方法本研究纳入2018年11月至2020年6月就诊于上海市第一人民医院普外科并经病理确诊的62例胃癌患者(胃癌组)和11例胃部良性疾病患者(对照组),采用差相富集技术(SE)与免疫荧光染色-染色体荧光原位杂交(i·FISH)整合成的SE-i·FISH技术检测患者的CTC和CTEC,分析CTC和CTEC与胃癌患者临床病理特征的关系。结果胃癌组CTC数目高于对照组,差异有统计学意义(t=2.693,P=0.009);胃癌组CTEC数目高于对照组,差异有统计学意义(t=2.015,P=0.048)。ROC曲线显示,当cut-off值定为9个细胞/6 ml血时,CTC在胃癌诊断中的灵敏度为84%,特异性为82%(AUC=0.876,95%CI,0.792~0.963,P<0.01);当cut-off值定为6个细胞/6 ml血时,CTEC在胃癌诊断中的灵敏度为50%,特异性为100%(AUC=0.727,95%CI,0.603~0.851,P=0.02)。CTC阳性与胃癌患者的肿瘤部位(χ^(2)=4.292,P=0.038)、TNM分期(CTC≥10时χ^(2)=4.848,P=0.028;CTC≥11时χ^(2)=6.234,P=0.013)有关,CTEC阳性与胃癌患者的血清CA19-9(χ^(2)=4.858,P=0.028)和血清CA724(χ^(2)=4.108,P=0.043)有关,差异均有统计学意义。结论SE-i·FISH技术在胃癌CTC和CTEC检测中具有较高的灵敏度和特异性,对于胃癌的辅助诊断和早期检测具有重要意义。

Objective To analyze the role of preoperative circulating tumor cell(CTC)and circulating tumor vascular endothelial cells(CTEC)in the diagnosis of gastric cancer and its correlation with the clinicopathological characteristics of gastric cancer.Methods Sixty-two gastric cancer patients and 11 patients of benign gastric diseases were enrolled.Subtraction enrichment(SE)and immunofluorescence staining-chromosome fluorescence in situ hybridization(i·FISH)were used to integrate the unique SE-i·FISH technology platform detecting patients′CTC and CTEC.Results The number of CTC in the gastric cancer group was significantly higher than that in the control group(t=2.693,P=0.009);the number of CTEC in the gastric cancer group was higher than the control group(t=2.015,P=0.048).With the cut-off value being set at 9 cells/6 ml in blood,the sensitivity of CTC in the diagnosis of gastric cancer is 84%,and the specificity is 82%(AUC=0.876,95%CI,0.792-0.963,P<0.01);When set at 6 cells/6 ml,the sensitivity of CTEC in the diagnosis of gastric cancer is 50%,and the specificity is 100%(AUC=0.727,95%CI,0.603-0.851,P=0.02).CTC positive is closely related to tumor location(χ^(2)=4.292,P=0.038)and TNM stage(CTC≥10,χ^(2)=4.848,P=0.028;CTC≥11,χ^(2)=6.234,P=0.013).CTEC positive is closely related to serum CA19-9(χ^(2)=4.858,P=0.028)and serum CA724(χ^(2)=4.108,P=0.043).Conclusion SE-i·FISH technology has high sensitivity and specificity in the detection of CTC and CTEC of gastric cancer.