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| 循环肿瘤细胞在局部进展期结直肠癌术后早期复发中的意义 |
| The significance of circulating tumor cells in early postoperative recurrence of locally advanced colorectal cancer |
| 投稿时间：2024-09-26 修订日期：2024-12-04 |
| DOI： |
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| 中文关键词: CytoSorter系统 循环肿瘤细胞 局部进展期结直肠癌 复发 |
| 英文关键词:CytoSorter system circulating tumor cells locally advanced colorectal cancer recurrence |
| 基金项目:陕西省重点研发计划项目(编号:S2020-YF-YBSF-0777) |
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| 中文摘要: |
| 目的 我们旨在探讨利用CytoSorter捕获系统检测循环肿瘤细胞(CTCs)的可行性,并评估CTCs作为局部进展期结直肠癌(LACRC)术后早期复发生物标志物的可能性。 方法 2018年1月至2020年2月共有144名LACRC患者参与了这项研究,手术前通过CytoSorter富集了外周血中的CTCs。将患者分为复发组(n=53例)以及未复发组(n=91例),并评价CTCs计数与患者临床病理特征的相关性。使用COX模型和Kaplan-Meier法分析CTCs计数与LACRC预后的关系。 结果 所有患者中术前CTCs中位计数为2.0(IQR:0.0-4.0)个/mL。CTCs阳性检出率[98例(68.06%)]显著高于CEA阳性率[73例(50.69%)](?2=8.997,P=0.003)。cTNM分期3期、未进行腹腔镜手术、疾病复发的患者CTCs数量和CTCs阳性率都显著高于cTNM分期2期、进行腹腔镜手术、疾病未复发的患者(P＜0.05)。与术前CTCs＜2个/mL患者相比,术前CTCs≥2个/mL患者的无进展生存期(RFS)降低(HR=2.761；95%CI=1.516-5.027；P=0.001),Log-Rank(Mantel-Cox)=12.175,P＜0.001。单变量分析显示,术前CTCs检出率、术后病理分期、淋巴血管侵犯、神经侵犯与RFS显著相关(P＜0.05)。多变量分析显示,即使在调整了术前病理分期、淋巴血管侵犯和神经侵犯后,CTCs状态(≥2个/mL)也是最重要的预后因素(P＜0.05)。 结论 这项研究表明术前CTCs可作为LACRC患者术后复发的监测工具,从而促进LACRC患者术后管理的风险分层和决策。 |
| 英文摘要: |
| Objective To investigate the feasibility of using the CytoSorter capture system to detect circulating tumor cells (CTCs) and to evaluate the potential of CTCs as a biomarker for early recurrence after surgery in locally advanced colorectal cancer (LACRC). Methods A total of 144 patients with LACRC participated in the study from January 2018 to February 2020, and CTCs in peripheral blood were enriched by CytoSorter prior to surgery. The patients were divided into recurrence group (n=53 cases) and non-recurrence group (n=91 cases), and the correlation between CTCs count and clinicopathological characteristics was evaluated. The COX model and Kaplan-Meier method were used to analyze the relationship between CTCs count and the prognosis of LACRC.Results The median preoperative CTCs count in all patients was 2.0 (IQR: 0.0-4.0) cells/mL. The positive detection rate of CTCs [98 cases (68.06%) was significantly higher than that of CEA (73 cases(50.69%)] (?2=8.997, P=0.003). The number of CTCs and the positive rate of CTCs in patients with cTNM stage 3, laparoscopic surgery and disease recurrence were significantly higher than those in patients with cTNM stage 2, laparoscopic surgery and no disease recurrence (P<0.05). Compared with patients with preoperative CTCs <2 cells/mL, the progression-free survival (RFS) of patients with preoperative CTCs≥2 cells/mL was reduced (HR=2.761; 95%CI=1.516-5.027; P=0.001), Log-Rank (Mantel-Cox)=12.175, P<0.001. Univariate analysis showed that the preoperative CTCs detection rate, postoperative pathological stage, lymphovascular invasion and nerve invasion were significantly correlated with RFS (P<0.05). Multivariate analysis showed that CTCs status (≥2 pcs/mL) was the most important prognostic factor even after adjusting for preoperative pathological stage, lymphovascular invasion and nerve invasion (P<0.05). Conclusion This study suggests that preoperative CTCs can be used as a monitoring tool for postoperative recurrence in LACRC patients, thereby facilitating risk stratification and decision-making in postoperative management of LACRC patients. |
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