口腔颌面部恶性肿瘤外周血循环肿瘤细胞检测及其临床意义

Detection of circulating tumor cells in peripheral blood of oral and maxillofacial malignant tumor patients and its clinical significance

目的:探讨口腔颌面部恶性肿瘤患者外周血中循环肿瘤细胞(circulating tumor cells,CTCs)的水平及其临床意义。方法:选择2019年5月—2020年5月于郑州大学第一附属医院就诊并被确诊为口腔颌面部恶性肿瘤的119例患者为实验组,20例健康人为对照组。应用循环肿瘤细胞检测技术检测外周血的CTCs值,分析其相关临床意义。结果:实验组的CTCs值高于对照组,且差异有统计学意义(P<0.001);实验组CTCs值与患者的性别、年龄、发病部位等临床特征无关(P>0.05);与肿瘤负荷(P=0.00052)、T分期(P=0.0041)、N分期(P=0.0019)、远处转移(P=0.0023)、临床分期(P=0.0022)、肿瘤周围组织浸润(P=0.016)、淋巴结转移(P=0.0018)等临床病理指标相关。CTCs诊断口腔颌面部恶性肿瘤的AUC值为0.932,检验能效性具有统计学意义(P<0.001,95%CI为0.916~0.950),当血CTCs值是8.45 FU/3 mL时,约登指数最大为0.866,诊断灵敏度为91.6%,特异度95.0%;CTCs诊断淋巴结转移的AUC值为0.693,检验能效性有统计学意义(P=0.003,95%CI为0.690~0.744),当CTCs值为12.25 FU/3 mL时,约登指数最大为0.434,诊断灵敏度69.0%,特异度74.4%。结论:外周血循环肿瘤细胞(CTCs)的检测,对口腔颌面部恶性肿瘤的早期筛查、辅助诊断、评估肿瘤的负荷大小,进展情况及肿瘤转移等均有重要的临床参考价值。

Objective:To investigate the level of circulating tumor cells(CTCs)in patients with oral and maxillofacial malignancies and its clinical significance.Methods:119 patients diagnosed as oral and maxillofacial malignant tumor from May 2019 to May 2020 were selected as the experimental group,and 20 healthy volunteers as the control group.The CTCs value of peripheral blood in patients was measured by the CTCs detection technology,and its clinical significance was analyzed.Results:CTCs values in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.001).CTCs values in the experimental group were not correlated with gender,age and location of the tumor(P>0.05).The values were correlated with tumor burden(P=0.00052),T stage(P=0.0041),N stage(P=0.0019),distant metastasis(P=0.0023),and clinical stage(P=0.0022).Values were also correlated with peripheral tissue infiltration(P=0.016),and lymph node metastasis(P=0.0018).The area under curve(AUC)value of peripheral blood CTCs in oral and maxillofacial malignancies diagnosis was 0.932,and the energy efficiency was statistically significant(P<0.001,95%CI 0.916-0.950).When the blood CTCs value was 8.45 FU/3 mL,the maximum value of the Yoden index was 0.866.The sensitivity and specificity of the diagnosis of oral and maxillofacial malignancies were 91.6%%and 95.0%.The AUC value of CTCs in the diagnosis of tumor metastasis was 0.693,and the energy efficiency was statistically significant(P=0.003,95%CI 0.690-0.744).When the CTCs value was 12.25 FU/3 mL,the maximum value of Yoden index was 0.434,the sensitivity was 69.0%,and the specificity was 74.4%.Conclusion:The detection of peripheral blood CTCs has important clinical significance in the auxiliary diagnosis.Determine the degree of tumor burden,degree of infiltration,metastasis tendency,and to quantitatively reflect the degree of tumor activity and the stage of disease development.