流式细胞术-DNA倍体分析在胃癌手术患者腹腔脱落肿瘤细胞检测中的应用效果

Application effect of flow cytometry-DNA ploidy analysis in the detection of peritoneal exfoliated tumor cells after gastric cancer surgery

目的探讨流式细胞术(FCM)-DNA倍体分析在胃癌手术患者腹腔脱落肿瘤细胞检测中的应用效果。方法对68例胃癌手术患者进行FCM-DNA倍体分析和腹腔冲洗细胞学(PLC)检测,比较FCM-DNA与PLC检测的阳性率,比较不同临床特征胃癌患者的FCM-DNA和PLC检测阳性率。采用受试者工作特征(ROC)曲线评估FCM-DNA和PLC检测对胃癌术后复发的预测价值,计算曲线下面积(AUC)。结果24例患者经PLC检测出脱落肿瘤细胞,阳性率为35.29%(24/68);46例患者经FCM-DNA检测出异倍体肿瘤细胞,阳性率为67.65%(46/68)。FCM-DNA检测肿瘤细胞的阳性率高于PLC,差异有统计学意义(P﹤0.05)。弥漫性、浆膜浸润、肿瘤侵袭面积≥10 cm^(2)、淋巴细胞转移阳性、肿瘤结节阳性、TNM分期为Ⅲ~Ⅳ期的胃癌患者FCM-DNA检测阳性率分别高于局限性、浆膜未浸润、肿瘤侵袭面积﹤10 cm^(2)、淋巴细胞转移阴性、肿瘤结节阴性、TNM分期为Ⅰ~Ⅱ期的患者,差异均有统计学意义(P﹤0.05)。局限性、弥漫性、浆膜浸润、浆膜未浸润、肿瘤侵袭面积≥10 cm^(2)、肿瘤侵袭面积﹤10 cm^(2)、肿瘤结节阴性、淋巴细胞转移阳性、Ⅰ~Ⅱ期、Ⅲ~Ⅳ期胃癌患者的FCM-DNA检测阳性率均高于PLC检测阳性率,差异均有统计学意义(P﹤0.05)。ROC曲线分析结果显示,FCM-DNA预测胃癌患者术后复发的AUC为0.785,PLC预测胃癌患者术后复发的AUC为0.641。结论采用FCM-DNA检测腹腔脱落肿瘤细胞的阳性率高,且对胃癌患者术后复发具有较高的预测价值,能够为胃癌患者的个体化治疗及预后评估提供依据。

Objective To explore the application effect of flow cytometry(FCM)-DNA ploidy analysis in the detection of peritoneal exfoliated tumor cells after gastric cancer surgery.Method A total of 68 patients with gastric cancer receive surgery were examined by FCM-DNA ploidy analysis and peritoneal lavage cytology(PLC).The difference of positive rate between FCM-DNA and PLC detection and the patients with different clinical characteristics were compared.The value of FCM-DNA and PLC detection in predicting postoperative recurrence of gastric cancer was evaluated with receiver operating characteristic(ROC)curve and the area under the curve(AUC)was calculated.Result Exfoliated tumor cells were detected by PLC in 24 patients,with a positive rate of 35.29%(24/68);aneuploid tumor cells were detected by FCM-DNA in 46 patients,with a positive rate of 67.65%(46/68).The positive rate of tumor cells detected by FCMDNA was higher than that of PLC(P<0.05).The positive rate of FCM-DNA detection in gastric cancer patients with diffuse,serosal infiltration,tumor invasion area≥10 cm^(2),positive lymphocyte metastasis,positive tumor nodules,and TNM stage Ⅲ-Ⅳ was higher than that of localized,non-serosal infiltration,tumor invasion area<10 cm^(2),negative lymphocyte metastasis,negative tumor nodules and TNM stage Ⅰ-Ⅱ(P<0.05).The positive rate of FCM-DNA dection in patients with localized,diffuse,serosal infiltration,non-serosal infiltration,tumor invasion area≥10 cm^(2),tumor invasion area<10 cm^(2),negative tumor nodules,positive lymphocyte metastasis,stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ gastric cancer was higher than that of PLC detection(P<0.05).The ROC curve showed that the AUC of FCM-DNA for predicting postoperative recurrence of gastric cancer was 0.785,and the AUC of PLC detection was 0.641.Conclusion FCM-DNA has higher positive rate in detecting exfoliated tumor cells and higher value in predicting postoperative recurrence of gastric cancer,which can be used to provide evidence for individualized treatment and prognosis evaluation of gastric cancer patients.