血浆EBV DNA变化预测晚期胃癌化疗近期疗效的价值

Value of Plasma EBV DNA Changes in Predicting the Short-term Efficacy of Chemotherapy for Advanced Gastric Cancer

目的探究胃癌患者血浆EBV DNA基础值及化疗后的变化及与化疗近期疗效间的关系。方法入组350例经影像学和组织病理学确诊为进展期的符合研究条件的胃腺癌患者,采取EBV-RNA(EBVR)原位杂交法及PCR诊断胃癌组织中是否存在EBV(EBV诊断金标准),将原位杂交法诊断胃腺癌组织中存在EBV阳性的胃腺癌患者筛选出后,应用PCR检测胃癌患者基础值和每2周期化疗前血浆EBV-DNA表达水平的变化;每完成2周期化疗,采用B超、CT等影像学检查评估肿瘤病灶,依据RECIST标准评价客观疗效,分析患者无进展生存率。结果每完成2周期化疗后进行两两比较,血浆EBV DNA阳性率较前明显下降,差异有统计学意义。每完成2周期化疗,结合阳性率,显示患者无进展人数与血浆EBV阳性具有相关性。结论血浆EBV DNA在胃腺癌中有较高的表达,对原位杂交法诊断EBV阳性的胃腺癌患者检测血浆EBV DNA的表达来预测晚期胃癌化疗的近期疗效具有一定的可行性和便利性。

Objective To explore the relationship between the basic value of plasma EBV DNA and changes after chemotherapy,as well as the short-term efficacy of chemotherapy.Methods 350 patients with advanced gastric adenocarcinoma confirmed by imaging and histopathology who met the research criteria were enrolled.EBV RNA(EBVR)in situ hybridization and PCR were used to diagnose the presence of EBV in gastric cancer tissue(EBV diagnostic gold standard).After screening out EBV positive gastric adenocarcinoma patients diagnosed by in situ hybridization in gastric adenocarcinoma tissue,PCR was used to detect changes in baseline values and plasma EBV-DNA expression levels in gastric cancer patients before every 2 cycles of chemotherapy;After completing 2 cycles of chemotherapy,tumor lesions were evaluated using imaging examinations such as B-ultrasound and CT,objective efficacy was evaluated based on RECIST criteria,and progression free survival rate was analyzed.Results After completing 2 cycles of chemotherapy,pairwise comparison was conducted,and the positive rate significantly decreased compared to before,with a statistically significant difference.Every 2 cycles of chemotherapy completed,combined with the positive rate,showed a correlation between the number of patients without progression and plasma EBV positivity.Conclusion Plasma EBV DNA is highly expressed in gastric adenocarcinoma,and it is feasible and convenient to detect the expression of plasma EBV DNA for predicting the short-term efficacy of chemotherapy in advanced gastric cancer patients diagnosed with EBV positive by in situ hybridization.