局部晚期食管癌患者循环肿瘤细胞与远期生存的关系研究

Relationship Between Circulating Tumor Cells and Long-term Survival in Patients with Locally Advanced Esophageal Cancer

目的 探讨局部晚期食管癌患者循环肿瘤细胞(CTCs)与远期生存的关系。方法 选取行食管癌根治术同时采用多西紫杉醇+顺铂方案化疗的64例局部晚期食管癌患者为研究对象,随访3年,均于治疗后留取7.5 ml空腹静脉血标本,采用细胞免疫荧光标记技术与阴性富集法评估患者CTCs表达情况,依据检测结果分为CTCs阳性组(n=28)和CTCs阴性组(n=36),采用Kaplan-Meier曲线获取患者远期生存情况,Cox回归模型分析相关变量指标与患者远期预后的关系。结果 随访3年,CTCs阳性组患者存活11例,生存率为39.29%,平均生存时间25.95个月,CTCs阴性组存活24例,生存率为66.67%,平均生存时间31.16个月,两组远期生存率比较差异有统计学意义(P<0.05);CTCs阳性组与CTCs阴性组BMI、肿瘤直径、肿瘤分化情况、CTCs、中心粒细胞/淋巴细胞比值(NLR)、血清肿瘤学指标细胞角蛋白19片段抗原21-1(CYFRA21-1)、血清白蛋白等指标比较差异有统计学意义(P<0.05);Cox回归模型分析结果显示:BMI、CTCs、NLR、血清白蛋白、CYFRA21-1为影响局部晚期食管癌患者远期生存的独立因素(P<0.05)。结论 CTCs水平为影响局部晚期食管癌患者远期生存的独立风险因素,可作为评估患者治疗后远期预后评估的重要生物学指标。

Objective To explore the relationship between circulating tumor cells(CTCs)and long-term survival in patients with locally advanced esophageal cancer.Methods A total of 64 patients with locally advanced esophageal cancer undergoing radical esophagectomy and docetaxel-cisplatin chemotherapy were enrolled as the research objects.All were followed up for 3 years.The samples of 7.5ml fasting venous blood were collected after treatment.The expressions of CTCs were evaluated by immunofluorescence labeling and negative enrichment.According to the test results,they were divided into CTCs-positive group(n=28)and CTCs-negative group(n=36).The long-term survival conditions of patients were obtained by Kaplan-Meier curves.The relationship between the relevant variables and long-term prognosis was analyzed by Cox regression model.Results After 3 years of follow-up,there were 11 survival cases in CTCs-positive group,with survival rate and mean survival time of 39.29%and 25.95 months.There were 24 survival cases in CTCs-negative group,with survival rate and mean survival time of 66.67%and 31.16 months.The differences in long-term survival rate between the two groups were statistically significant(P<0.05).The differences in BMI,tumor diameter,tumor differentiation,CTCs,neutrophil/lymphocyte ratio(NLR),cytokeratin 19 fragment antigen 21-1(CYFRA21-1)and serum albumin between the two groups were statistically significant(P<0.05).The results of Cox regression model analysis showed that BMI,CTCs,NLR,serum albumin and CYFRA21-1 were independent influencing factors of long-term survival in patients with locally advanced esophageal cancer(P<0.05).Conclusion CTCs is an independent risk factor of long-term survival in patients with locally advanced esophageal cancer,which can be applied as an important biological index to evaluate long-term prognosis.