循环肿瘤细胞计数评估高龄中晚期非小细胞肺癌患者预后的价值分析

Analysis of the prognostic value of circulating tumor cells count in elderly patients with advanced non-small cell lung cancer

目的分析外周血循环肿瘤细胞(Circulating tumor cells,CTCs)水平在评估保守治疗的高龄中晚期老年非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者预后中的价值。方法选取2017年1月~2019年4月在我院住院、TNM临床分期为Ⅲ或Ⅳ期仅保守治疗的高龄NSCLC患者为研究对象。采集患者的年龄、性别、吸烟情况、病理类型、TNM分期和血清肿瘤标记物(CEA和CA125)水平等临床资料。采用全自动循环肿瘤活细胞捕获仪器分选富集CTCs,利用免疫荧光原位杂交技术判别CTCs并计数。根据CTCs的检出数目将患者分为3组,阴性组(CTCs计数<2个),低负荷组(2个≤CTCs计数<5个),高负荷组(CTCs计数≥5个)。追踪所有患者的中位生存期,分析患者的基线CTCs计数与临床资料的关系,应用单因素及多因素分析方法研究临床资料及基线CTCs水平对患者生存期的影响。结果最终纳入52例NSCLC患者,其中阴性组20例,低负荷组19例,高负荷组13例,三组性别、吸烟情况差异无统计学意义(P>0.05)。高负荷组病理类型中腺癌多见(P<0.05),低负荷组及高负荷组的TNM分期更高(P<0.05)。阴性组与高负荷组的CA125水平差异有统计学意义(P<0.05)。单因素分析表明年龄、TNM分期、血清CA125水平及CTCs水平对中位生存期有影响(P<0.05)。进一步多因素分析模型显示外周血CTCs水平是影响生存时间的独立影响因素(P<0.05),三组患者的中位生存期分别为:阴性组10个月,低负荷组5个月,高负荷组3个月,生存曲线分析提示三组间差异有统计学意义(P<0.05)。结论保守治疗的高龄中晚期NSCLC患者外周血CTCs水平是患者生存时间的独立影响因素,外周血CTCs水平对高龄中晚期NSCLC患者的预后有一定的预测价值。

Objective To evaluate the prognostic value in elderly patients with advanced non-small cell lung cancer(NSCLC)by detecting the level of circulating tumor cells(CTCs)in peripheral blood.Methods From Jan 2017 to Apr 2019,the elderly advanced NSCLC patients who were hospitalized in our hospital and only conservatively treated were enrolled in the research.Clinical data such as age,gender,smoking status,pathological type,TNM stage,tumor markers(CEA and CA125)was collected.CTCs were sorted and enriched by a fully automatic circulating tumor cell capture instrument,and CTCs were identified and counted by immunofluorescence in situ hybridization.According to the number of CTCs detected,patients were divided into 3 groups,negative group(CTCs count<2),low-load group(2≤CTCs count<5),and high-load group(CTCs count≥5).The median survival time of all patients was tracked.The relationship between the patient’s baseline CTCs count and clinical data was analyzed.Univariate and multivariate analysis were applied to analyze the impacts of clinical data and baseline CTCs level on survival.Results A total of 52 patients were finally included in the research,including 20 in the negative group,19 in the low-load group and 13 in the high-load group.There was no significant difference in gender and smoking status among the three groups(P>0.05).Adenocarcinoma was more common in the pathological types of the high-load group(P<0.05),and the TNM stage of the low-load group and the high-load group was higher(P<0.05).There was statistically significant difference in CA125 serum level between the negative group and the high-load group(P<0.05).Univariate analysis showed that age,TNM stage,serum CA125 level and CTCs level had impacts on median survival(P<0.05).Further multivariate analysis showed that the level of peripheral blood CTCs was an independent factor median survival time(P<0.05).The median survival time of the three groups was 10 months for the negative group,5 months for the low-load group,3 months for the high-load group.Survival analysis curve suggested that the difference among the three groups was statistically significant(P<0.05).Conclusion Peripheral blood CTCs level in conservatively treated elderly patients with advanced NSCLC is an independent factor affecting the patient’s survival time.The baseline level of CTCs has a certain predictive value for the prognosis.