叶酸受体阳性循环肿瘤细胞检测在胃癌患者中的临床意义及相关性分析

The significance and correlation analysis of folate receptor positive circulating tumor cells in patients with gastric cancer

目的 研究叶酸受体阳性循环肿瘤细胞(folate receptor positive circulating tumor cells, FR+CTC)检测在胃癌患者中的临床意义。方法 回顾性分析术前检测过FR+CTC表达量的胃癌手术患者的临床资料。绘制FR+CTC、白蛋白、总蛋白、血红蛋白、CA125、CA199及CEA预测胃癌患者合并腹膜转移、淋巴结转移、脉管侵犯、神经侵犯、肿瘤突破浆膜层及进展期胃癌的ROC曲线。研究FR+CTC值与胃肠道肿瘤标志物和临床常用营养指标相关的相关性。探讨FR+CTC值及临床相关指标在不同类型胃癌中表达量的统计学差异情况。结果 FR+CTC诊断胃癌患者合并腹膜转移、淋巴结转移、脉管侵犯、神经侵犯、肿瘤突破浆膜层及Ⅲ~Ⅳ期胃癌的AUC值分别为0.933、0.653、0.614、0.628、0.714、0.703,明显优于传统肿瘤标志物(CEA、CA199、CA125)。通过Spearman相关性分析显示,FR+CTC值与白蛋白含量呈负相关(R=-0.26,P=0.0043)。FR+CTC表达量在腹膜转移、淋巴结转移、脉管侵犯、神经侵犯、肿瘤突破浆膜层及Ⅲ~Ⅳ期胃癌患者中明显增加,差异均有统计学意义(P<0.05)。结论 FR+CTC值较传统肿瘤标志物能更准确地预测胃癌患者合并腹膜转移、淋巴结转移、脉管侵犯、神经侵犯、肿瘤突破浆膜层及肿瘤处于Ⅲ~Ⅳ期的概率,并且FR+CTC在这些类型胃癌患者中表达量明显增加,可常规作为新型的临床肿瘤标志物。

Objective To explore the clinical significance of folate receptor positive circulating tumor cells(FR+CTC)in patients with gastric cancer.Methods A retrospective analysis the clinical data of gastric cancer surgery patients who had preoperative detection of FR+CTC expression.ROC curves were drawn for FR+CTC,albumin,total protein,hemoglobin,CA125,CA199 and CEA to predict peritoneal metastasis,lymph node metastasis,vascular invasion,nerve invasion,tumor breakthrough serosal and advanced gastric cancer in patients.The correlation between FR+CTC values and gastrointestinal tumor markers and commonly used clinical nutritional indicators was investigated.The statistical difference in the expression of FR+CTC values and clinical related indicators in different types of gastric cancer was explored.Results The AUC values of FR+CTC in diagnosing peritoneal metastasis,lymph node metastasis,vascular invasion,nerve invasion,tumor breakthrough serosal and stageⅢ-Ⅳgastric cancer were 0.933,0.653,0.614,0.628,0.714 and 0.703,respectively,which were significantly better than traditional tumor markers(CEA,CA199,CA125).Through Spearman correlation analysis,the FR+CTC value was negatively correlated with albumin content,with a correlation coefficient(R=-0.26,P=0.0043).The expression of FR+CTC in patients with peritoneal metastasis,lymph node metastasis,vascular invasion,nerve invasion,tumor breakthrough serosal and stageⅢ-Ⅳgastric cancer was significantly increased,and the difference was statistically significant.Conclusion The FR+CTC value can more accurately predict the probability of gastric cancer patients with peritoneal metastasis,lymph node metastasis,vascular invasion,nerve invasion,tumor breakthrough serosal and tumors in stageⅢ-Ⅳ.Moreover,the expression of FR+CTC in these types of gastric cancer patients is significantly increased,which can be routinely used as a new type of clinical tumor marker.