Ⅲ期结直肠癌患者术后外周血循环肿瘤细胞表达对肝转移的预测价值

Predictive value of postoperative expression of circulating tumor cells in peripheral blood for liver metastasis in patients with stage Ⅲ colorectal cancer

目的观察Ⅲ期结直肠癌手术患者外周血循环肿瘤细胞(CTCs)表达情况,探究术后外周血CTCs表达对肝转移发生风险的预测价值。方法前瞻性研究。抽取2020年1月至2023年4月驻马店市第一人民医院收治的109例Ⅲ期结直肠癌手术患者为研究对象,于术前及术后2、15、30 d对患者进行CTCs检查,包括CTCs计数、分型。所有患者术后均随访1年,统计患者术后肝转移发生情况,并依据肝转移发生情况将其分为发生组与未发生组。比较两组手术前后CTCs计数,并绘制受试者工作特征曲线分析术后CTCs对患者肝转移的预测价值。统计两组术后30 d时CTCs分型情况。结果109例Ⅲ期结直肠癌患者术后发生肝转移42例,占38.53%(42/109)。术后2 d,两组CTCs计数均高于术前,术后15、30 d,两组CTCs计数较术后2 d逐渐降低(P<0.05);术前及术后2、15、30 d,发生组CTCs计数均高于未发生组(P均<0.05)。绘制受试者工作特征曲线结果显示,术后2、15、30 d,CTCs计数预测Ⅲ期结直肠癌术后肝转移的曲线下面积均≥0.7,均有一定的预测价值。术后30 d,发生组CTCs分型以间质型为主,占比(71.43%,30/42)高于未发生组(16.42%,11/67),P<0.05。结论Ⅲ期结直肠癌患者术后CTCs计数高、单纯间质型CTCs与患者术后肝转移发生有关,多时点检测患者术后CTCs计数有助于预测患者肝转移发生风险。

Objective To observe the expression of circulating tumor cells(CTCs)in peripheral blood in patients with surgery for stage Ⅲ colorectal cancer,and investigate the predictive value of postoperative CTCs expression for liver metastasis in patients.Methods This study was a prospective study that included 109 patients with stage Ⅲ colorectal cancer who underwent surgery in the First People’s Hospital of Zhumadian from January 2020 to April 2023 as the study subjects.CTCs were examined before and at 2,15,and 30 days after surgery,including CTCs count and typing.All patients were followed up for 1 year after surgery.The occurrence of postoperative liver metastasis was counted.And the patients were divided into the occurrence group and the non occurrence group according to occurrence of liver metastasis.The CTCs count of the two groups were compared before and after operation.The receiver operating characteristic curve was drawn to analyze the predictive value of postoperative CTCs for liver metastasis.The CTCs typing of the two groups at 30 days after operation were recorded.Results Forty-two of 109 patients with stage Ⅲ colorectal cancer experienced postoperative liver metastasis,accounting for 38.53%(42/109).Two days after surgery,the CTCs count in both groups were higher than those before surgery(P<0.05);15 and 30 days after surgery,the CTCs count in both groups gradually decreased,compared with 2-day postoperative CTCs count(P<0.05).Before surgery and 2,15 and 30 days after surgery,the CTCs count in the occurrence group were higher than those in the non occurrence group(all P<0.05).Results of the receiver operating characteristic curve showed that the area under the curve of 2-15-and 30-day postoperative CTCs count in predicting postoperative liver metastasis in patients with stage Ⅲ colorectal cancer were≥0.7,all of which had certain predictive value.Thirty days after surgery,the CTCs in the occurrence group were mainly classified as interstitial type,with a higher proportion of cases(71.43%,30/42),compared with the non occurrence group(16.42%,11/67),P<0.05.Conclusions Patients with stage Ⅲ colorectal cancer have a high CTCs count after surgery,and simple interstitial CTCs are associated with postoperative liver metastasis.Multitemporal detection of postoperative CTCs count in patients can help to predict the risk of liver metastasis.