叶酸受体阳性循环肿瘤细胞检测对肝细胞癌病人合并血管侵犯的诊断价值

The diagnostic value of folate receptor-positive circulating tumor cells detection in patients with hepatocellular carcinoma with vascular invasion

目的探讨叶酸受体阳性循环肿瘤细胞(FR^(+)-CTCs)检测对肝细胞癌病人(HCC)合并血管侵犯的诊断价值。方法前瞻性收集2020年10月~2021年8月我院收治的HCC住院病人91例,利用免疫磁珠负向筛选+靶向荧光定量PCR法检测其外周血液中的FR^(+)-CTCs。根据病人术前影像学检查和术后病理结果分为无血管侵犯(NVI)组30例,微血管侵犯(MVI)组26例,门静脉癌栓(PVTT)组35例。分析3组病人FR^(+)-CTCs检测值差异。结果3组病人FR^(+)-CTCs检测值的平均水平分别为(10.52±2.21)FU/3 ml,(12.35±2.47)FU/3 ml,(14.79±3.68)FU/3 ml,3组比较差异有统计学意义(P<0.05)。FR^(+)-CTCs检测值与HCC血管侵犯程度存在正相关性(r=0.499,P<0.05)。分别以FR^(+)-CTCs作为有无血管侵犯和PVTT的辅助诊断指标,其ROC曲线下面积分别为0.769(95%CI为0.668~0.869)和0.830(95%CI为0.733~0.928);当分别取截断点为12.35 FU/3 ml和11.8 FU/3 ml时,其诊断灵敏度分别为0.672和0.829、特异度分别为0.767和0.733。结论FR^(+)-CTCs检测值与HCC血管侵犯程度存在正相关,FR^(+)-CTCs检测值对有无血管侵犯和PVTT有较高的辅助诊断价值,但对MVI诊断价值较低。

Objective To explore the diagnostic value of folate receptor-positive circulating tumor cells(FR^(+)-CTCs)in patients with hepatocellular carcinoma(HCC).Methods From October 2020 to August 2021,91 cases of HCC in the Department of Liver Surgery of Tongji Hospital were prospectively collected,and the detection values of FR^(+)-CTCs in peripheral blood bodies were measured by immunomagnetic bead negative screening and targeted fluorescence quantitative PCR.The patients were divided into non-vascular invasion group(NVI)(n=30),microvascular invasion group(MVI)(n=26)and portal vein tumor thrombus group(PVTT)(n=35)according to preoperative imaging and postoperative pathological results.The difference of FR^(+)-CTCs among 3 groups was analyzed.Results The average values of FR^(+)-CTCs in the three groups were(10.52±2.21)FU/3 ml,(12.35±2.47)FU/3 ml,(14.79±3.68)FU/3 ml(P<0.05).There was a positive correlation between the detection value of FR^(+)-CTCs and the degree of vascular invasion in patients with HCC(r=0.499,P<0.05).FR^(+)-CTCs were used as auxiliary diagnostic indicators for vascular invasion and PVTT,and the area under the ROC curve was 0.769(95%CI was 0.668-0.869)and 0.830(95%CI was 0.733-0.928),respectively.When the cut-off points were 12.35 FU/3 ml and 11.8 FU/3 ml,respectively,the diagnostic sensitivity was 0.672 and 0.829,and the specificity was 0.767 and 0.733,respectively.Conclusion The detection value of FR^(+)-CTCs was positively correlated with the degree of vascular invasion in HCC patients,and the detection value of FR^(+)-CTCs had higher auxiliary diagnostic value for patients with vascular invasion and PVTT,but lower diagnostic value for MVI in patients with HCC.