| 黄 薇,轩乾坤,吴 寅.晚期胃癌外周循环肿瘤细胞与血液高凝状态及预后的相关性研究[J].肿瘤学杂志,2019,25(8):691-697. |
| 晚期胃癌外周循环肿瘤细胞与血液高凝状态及预后的相关性研究 |
| Association of Circulating Tumor Cells with Hypercoagulation Status and Prognosis of Patients with Advanced Gastric Cancer |
| 投稿时间：2018-02-25 |
| DOI：10.11735/j.issn.1671-170X.2019.08.B003 |
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| 中文关键词: 胃肿瘤 晚期 循环肿瘤细胞 高凝状态 D二聚体 |
| 英文关键词:gastric cancer advanced circulating tumor cells hypercoagulation D-Dimer |
| 基金项目:国家自然科学基金（81502510）；上海市卫生与计划委员会课题（201440318）；上海市科学技术委员会课题（17411968800）；东方旭日人才计划 |
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| 中文摘要: |
| 摘 要：［目的］ 研究晚期不可切除胃癌患者外周循环肿瘤细胞（circulating tumor cells，CTCs）与凝血功能指标之间关系，探讨CTCs及血液高凝指标在晚期胃癌患者生存及预后中的作用。［方法］ 收集晚期不可切除胃癌患者28例，采用阴性富集法检测基线CTCs，并检测血常规及凝血功能指标，分析CTCs与凝血功能指标及血小板之间相关性；随访分析基线CTCs、凝血功能指标与患者生存的关系，Cox回归分析各因子在患者预后中的作用。［结果］28例晚期不可切除胃癌患者中，基线CTCs及凝血指标异常，尤其是D-二聚体、纤维蛋白原降解产物（FDG）升高明显，与患者年龄、性别、是否存在远隔脏器转移无关（P>0.05）。相关分析显示基线CTCs与凝血指标D-二聚体、FDG呈正相关（P<0.001），而与抗凝血指标AT-Ⅲ呈负相关（P<0.05）；抗肿瘤及抗凝治疗后，高凝指标较治疗前有明显改善（P<0.01）。基线CTCs<4个/3.2ml外周血患者PFS较CTCs≥4个/3.2ml患者明显延长（P<0.01），但OS在两组间差异未达统计学意义（P=0.051）。Cox回归分析显示D-二聚体升高是晚期不可切除胃癌患者疾病进展独立预后因子（HR=1.440，95%CI：1.151～1.803，P<0.05），而与OS无明显相关性（HR=1.239，95%CI：0.992~1.547，P>0.05）。［结论］ 晚期不可切除胃癌患者CTCs与患者高凝状态、疾病进展相关，可能存在CTCs-高凝-转移的恶性循环，积极抗凝及抗肿瘤治疗可能阻断这一恶性循环，改善高凝状态减少转移。 |
| 英文摘要: |
| Abstract：［Objective］ To study the relationship of circulating tumor cells (CTCs) with coagulation factors and the prognosis of patients with advanced gastric cancer. ［Methods］ Blood samples were collected from 28 patients with advanced unresectable gastric cancer，the CTCs were enriched by negative immunomagnetic separation and identified by immunofluorescence method. Plasma coagulation factors，including D-Dimer，PT，APTT，FDG，AT-Ⅲ，PLT and FIB were determined. The relationship between CTCs and coagulation factors was analyzed before and after anti-cancer treatment. The prognostic factors of advanced gastric cancer were examined by Cox regression analysis. ［Results］ CTCs and coagulation factors，especially D-dimer and FDG were abnormal in advanced gastric cancer patients，which were not correlated with age，gender or distant metastasis of patients(P>0.05). CTCs were positively correlated with D-Dimer and FDG (P<0.001)，and negatively correlated with AT-Ⅲ(P<0.05). Hypercoagulation status was improved significantly after chemotherapy and anti-coagulation treatment(P<0.01). Patients with baseline CTCs<4/3.2ml had longer PFS than those ≥4/3.2ml(P<0.01)，but the difference in OS was not significant between the two groups(P=0.051). Regression analysis revealed that D-Dimer was independent prognostic factor for PFS(HR=1.440，95%CI：1.151~1.803，P<0.05)，but not for OS(HR=1.239，95%CI：0.992~1.547，P>0.05). ［Conclusion］ CTCs is associated with hypercoagulation status of patients，which would further affect the progression of advanced unresectable gastric cancer. |
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