循环肿瘤细胞检测在食管胃交界腺癌患者中的临床价值

Clinical value of count of circulating tumor cells detection in patients with adenocarcinoma of esophagogastric junction

目的研究外周血循环肿瘤细胞(CTCs)计数与食管胃交界腺癌(AEG)患者临床特征和总生存期(OS)的关系,探讨CTCs检测在AEG患者中的临床应用价值。方法回顾性分析聊城市人民医院2016年7月—2020年6月收治的154例AEG患者的临床资料,患者治疗前1周均采用阴性富集-荧光原位杂交技术行CTCs检测,分析CTCs计数与患者临床特征及OS的关系。结果在早期(Ⅰ~Ⅱ期)AEG患者中,CTCs阳性率为57.1%(32/56),癌胚抗原(CEA)、糖类抗原(CA)19-9、CA72-4的阳性率分别为19.6%(11/56)、1.8%(1/56)、12.5%(7/56)。不同CTCs计数AEG患者脉管内瘤栓(χ^(2)=45.262,P<0.001)、TNM分期(χ^(2)=14.304,P<0.001)、淋巴结转移(χ^(2)=5.158,P=0.023)差异均有统计学意义。Log-rank单因素分析提示,CTCs≥2(χ^(2)=12.486,P<0.001)以及CTCs≥3(χ^(2)=45.344,P<0.001)与AEG患者OS相关。Cox多因素分析显示,CTCs≥3(HR=2.459,95%CI:1.472~4.107,P=0.001)是AEG患者OS的独立危险因素。结论阴性富集-荧光原位杂交技术检测CTCs可作为早期AEG患者的辅助诊断指标,与AEG患者的病理分期以及肿瘤复发转移相关,CTCs≥3可作为AEG患者预后不良的独立危险因素,具有一定的临床应用价值。

Objective To investigate the relationship between the count of circulating tumor cells(CTCs) in peripheral blood and the clinical characteristics and overall survival(OS) of patients with adenocarcinoma of esophagogastric junction(AEG),and to explore the clinical application value of CTCs detection in AEG patients.Methods A total of 154 patients with AEG were eligible for enrollment in Liaocheng People's Hospital from July 2016 to June 2020 in the retrospective study.Negative enrichment techniques and fluorescence in situ hybridization(NE-FISH) were used to detect CTCs one week before treatment and the relationship between CTCs count and clinical characteristics of AEG patients was then investigated.Moreover,relationship between CTCs count and OS in prognosis were also explored.Results The positive rate of CTCs was 57.1%(32/56) and the positive rates of CEA,CA19-9 and CA72-4 were 19.6%(11/56),1.8%(1/56) and 12.5%(7/56) respectively in the early AEG patients.The presence of CTCs was significantly correlated with AEG patients,CTCs were positive(≥2) in patients with AEG was significantly correlated with intravascular tumor thrombus(χ^(2)=45.262,P<0.001),TNM stage(χ^(2)=14.304,P<0.001)and lymph node metastasis(χ^(2)=5.158,P=0.023).Log-rank univariate analysis showed that CTCs ≥ 2(χ^(2)=12.486,P<0.001) and CTCs ≥ 3(χ^(2)=45.344,P<0.001) were closely related to OS in AEG patients(P<0.001).Cox multivariate analysis showed that CTCs ≥ 3(HR=2.459,95% CI:1.472-4.107,P=0.001) was an independent risk factor for the prognosis of OS in AEG patients.Conclusion The detection of CTCs by negative enrichment fluorescence in situ hybridization can be used as an auxiliary diagnostic indicator for early AEG patients,which is closely related to the pathological stage of AEG patients and tumor recurrence and metastasis.CTCs ≥ 3 can be used as an independent risk factor for poor prognosis of AEG patients and have a certain clinical application value.