循环肿瘤细胞协同代谢指标预测乳腺癌复发的临床研究

Clinical study of circulating tumor cell in combination with metabolic markers predicting the risk of breast cancer recurrence

目的探讨乳腺癌外周血循环肿瘤细胞(CTCs)与临床病理特征的关系,以及其中代谢相关指标对乳腺癌复发转移高危人群的诊断价值。方法收集华中科技大学附属协和医院2020年1月至2022年12月期间完成包括手术在内的完整综合治疗方案的97例乳腺癌患者的临床资料,采集并检测患者外周血CTCs,将CTCs≥5个定义为阳性(32例),CTCs<5个为阴性(65例),分析CTCs数量与患者临床病理特征的相关性,进一步评估其中代谢相关指标的诊断价值。结果在97例乳腺癌患者中,超重或肥胖者、空腹血糖水平较高者、血乳酸脱氢酶(LDH)水平高者CTCs阳性率分别为58.8%(10/17)、66.7%(10/15)、75.0%(9/12),差异有统计学意义(P<0.05)。ROC曲线分析结果显示,外周血LDH诊断CTCs阳性的曲线下面积为0.719,体重指数(BMI)为0.591,空腹血糖为0.584;相关性分析结果显示,外周血LDH水平与CTCs数量明显相关(R=0.213,P<0.05)。此外,ROC曲线分析验证CTCs数量对乳腺癌复发的诊断价值,曲线下面积为0.673。结论乳腺癌患者BMI、空腹血糖及外周血LDH水平较高者CTCs阳性检出率较高,其中LDH用于筛选乳腺癌复发转移高危人群的潜在诊断价值最高;CTCs阳性的乳腺癌患者具有较高的复发风险。

Objective To explore the association between clinicopathological characteristics of breast cancer and circulating tumor cells(CTCs)in peripheral blood as well as the diagnostic value of its metabolism-related indices in the high-risk group of recurrent metastasis.Methods From January 2020 to December 2022,clinical data from 97 breast cancer patients who underwent surgery at Union Hospital of Huazhong University of Science and Technology were obtained.CTCs were also collected:CTCs≥5 were defined as positive(32 in total),and CTCs<5 were defined as negative(65 in total).Then we analyzed the correlation between the number of CTCs and patients’clinicopathological features.The diagnostic value of their metabolism-related indexes was further assessed as well.Results Among the 97 patients,the positive rates of CTCs in overweight or obese patients,those with high fasting glucose levels,and those with high blood lactate dehydrogenase(LDH)levels were 58.8%(10/17),66.7%(10/15),and 75.0%(9/12),and the differences were statistically significant(P<0.05).According to the ROC curve analysis,the area under the curve of the positive-CTCs diagnosed by peripheral blood LDH was 0.719,body mass index(BMI)was 0.591,and fasting blood glucose was 0.584.The correlation analysis revealed a significant correlation between the LDH level and the number of CTCs(R=0.214,P<0.05).In addition,ROC curve analysis verified the diagnostic value of the number of CTCs for breast cancer recurrence,and the area under the curve was 0.673.Conclusion Breast cancer patients with higher BMI,fasting blood glucose level,and peripheral blood LDH level have a higher detection rate of positive-CTCs,among which LDH has the highest potential value for screening the high-risk group of breast cancer recurrence.CTCs-positive breast cancer patients have a higher risk of recurrence.