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
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
作者单位
黄 薇 同济大学附属东方医院 
轩乾坤 同济大学附属东方医院 
吴 寅 同济大学附属东方医院 
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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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