切换至 "中华医学电子期刊资源库"
高级检索
中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 19 -22. doi: 10.3877/cma.j.issn.1674-0793.2020.01.006

所属专题： 专题评论； 文献；

论著

循环肿瘤细胞检测在晚期乳腺癌化疗疗效评价中的价值探讨
江秋晨1, 杨大伟2, 解磐磐1, 张伟1, 杨永瑞3, 崔兆清1,†()   
  1. 1. 252000　聊城市人民医院乳腺、甲状腺及疝外科
    2. 252000　聊城市人民医院中原生物医学研究院
    3. 271000　泰安，山东第一医科大学研究生部
  • 收稿日期:2018-10-28 出版日期:2020-02-01
  • 通信作者: 崔兆清

Study on the value of circulating tumor cells detection in the evaluation of chemotherapy efficacy of advanced breast cancer

Qiuchen Jiang1, Dawei Yang2, Panpan Xie1, Wei Zhang1, Yongrui Yang3, Zhaoqing Cui1,†()   

  1. 1. Department of Breast, Thyroid and Hernia Surgery, Liaocheng People’s Hospital, Liaocheng 252000, China
    2. Zhongyuan Biomedical Research Institute, Liaocheng People’s Hospital, Liaocheng 252000, China
    3. Graduate School, Shandong First Medical University, Taian 271000, China
  • Received:2018-10-28 Published:2020-02-01
  • Corresponding author: Zhaoqing Cui
  • About author:
    Corresponding author: Cui Zhaoqing, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

江秋晨, 杨大伟, 解磐磐, 张伟, 杨永瑞, 崔兆清. 循环肿瘤细胞检测在晚期乳腺癌化疗疗效评价中的价值探讨[J/OL]. 中华普通外科学文献(电子版), 2020, 14(01): 19-22.

Qiuchen Jiang, Dawei Yang, Panpan Xie, Wei Zhang, Yongrui Yang, Zhaoqing Cui. Study on the value of circulating tumor cells detection in the evaluation of chemotherapy efficacy of advanced breast cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(01): 19-22.

目的

探讨循环肿瘤细胞（CTC）在晚期乳腺癌患者化疗疗效评估中的价值。

方法

选取2016年7月至2018年6月聊城市人民医院乳腺中心确诊为晚期乳腺癌的患者50例，通过免疫磁珠阴性富集CTC、免疫荧光原位杂交（FISH）鉴定CTC，得出晚期乳腺癌患者化疗期间外周血中CTC的数目。收集患者影像学及血清学指标资料，比较患者化疗期间CTC数目的变化，并与影像学及血清学指标进行对比。

结果

18例（36.0%）首次CTC≥5个，28例（56.0%）≥1个，4例（8.0%）未发现CTC；化疗后CTC数目减少者32例，增加者18例。CTC与影像学指标变化基本一致，而且CTC计数改变与影像学指标在评估疾病变化过程中未见明显差异（kappa=0.65，χ2=0.125，P=0.724）；血清学指标在晚期乳腺癌病情发展过程中的变化与影像学对比差异有统计学意义，CEA（kappa=0.19，χ2=4.267，P=0.039），CK19（kappa=0.16，χ2=6.667，P=0.010），CA15-3（kappa=0.01，χ2=4.500，P=0.034）。

结论

CTC计数对于预测晚期乳腺患者病情发展有一定的临床价值，CTC计数改变在晚期乳腺癌患者中预测疾病进展风险比血清学指标更加敏感。

关键词: 肿瘤细胞，循环, 乳腺肿瘤, 化疗, 敏感性
Objective

To investigate the value of circulating tumor cells (CTC) in evaluating the efficacy of chemotherapy in patients with advanced breast cancer.

Methods

Fifty patients with advanced breast cancer diagnosed in the Breast Center of Liaocheng People’s Hospital from July 2016 to June 2018 were selected. Negative enrichment, immunocytochemistry CD45 staining and ?uorescence in situ hybridization (FISH) was used to identify, enumerate and characterize CTC during chemotherapy of advanced breast cancer patients, and the data of imaging and serological indexes were collected to compare the changes of CTC number during chemotherapy of patients and to compare with imaging and serological indexes.

Results

For the first time, there were 18 cases (36.0%) with CTC count 5, 28 cases (56.0%) with CTC count 1, and 4 cases (8.0%) with no CTC. The number of CTC was decreased in 32 cases and increased in 18 cases. The changes of CTC and imaging indicators were basically the same, and there was no significant difference between the changes of CTC count and imaging indicators in evaluating disease changes (kappa=0.65, χ2=0.125, P=0.724). The changes of serological indicators in the development of advanced breast cancer were statistically significant compared with those of imaging CEA (kappa=0.19, χ2=4.267, P=0.039), CK19 (kappa=0.16, χ2=6.667, P=0.010), CA15-3 (kappa=0.01, χ2=4.500, P=0.034).

Conclusion

CTC counts have certain clinical value in predicting the disease progression of patients with advanced breast cancer, and changes in CTC counts are more sensitive than serological indicators in predicting the risk of disease progression for patients with advanced breast cancer.

Key words: Neoplastic cells, circulating, Breast neoplasms, Chemotherapy, Sensitivity
图1 阴性富集-FISH技术鉴定出的循环肿瘤细胞（CTC）在显微镜下的示例图　DAPI：4',6-二脒基-2-苯基吲哚，蓝色；CD45：白细胞共同抗原，红色；CEP8：8号染色体着丝粒探针，橙色；CEP17：17号染色体着丝粒探针，绿色；Merge：不同荧光通道的合图
表1 晚期乳腺癌50例化疗后血清学指标变化与影像学有效性的一致性分析（例）
血清学指标 影像学 kappa值 χ2值 P值
有效 无效
CEA
降低 31 12 0.19 4.267 0.039
升高 3 4
CK19
降低 32 13 0.16 6.667 0.010
升高 2 3
CA15-3
降低 30 14 0.01 4.500 0.034
升高 4 2
[1]
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[2]
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Peto R, Davies C, et al. Comparisons between different polychemotherapy regimens for early breast cancer: Meta-analyses of long-term outcome among 100 000 women in 123 randomised trials[J]. Lancet, 2012, 379(9814): 432-444.
[3]
郭瑢，吴炅. 循环肿瘤细胞在乳腺癌个体化诊治中的研究进展[J/CD]. 中华乳腺病杂志(电子版), 2018, 12(3): 177-181.
[4]
Giordano A, Giuliano M, De Laurentiis M, et al. Circulating tumor cells in immunohistochemical subtypes of metastatic breast cancer: lack of prediction in HER2-positive disease treated with targeted therapy[J]. Ann Oncol, 2012, 23(5): 1144-1150.
[5]
Wicha MS, Hayes DF. Circulating tumor cells:not all detected cells are bad and not all bad cells are detected[J]. J Clin Oncol, 2011, 29(12): 1508-1511.
[6]
Cristofanilli M, Budd GT, Ellis MJ, et al. Circulating tumor cells, disease progression, and survival in metastatic breast cancer[J]. N Engl J Med, 2004, 351(8): 781-791.
[7]
Smerage JB, Barlow WE, Hortobagyi GN, et al. Circulating tumor cells and response to chemotherapy in metastatic breast cancer: SWOG S0500[J]. J Clin Oncol, 2014, 32(31): 3483-3489.
[8]
Turker I, Uyeturk U, Sonmez OU, et al. Detection of circulating tumor cells in breast cancer patients: prognostic predictive role[J]. Asian Pac J Cancer Prev, 2013, 14(3): 1601-1607.
[9]
Wallwiener M, Riethdorf S, Hartkopf AD, et al. Serial enumeration of circulating tumor cells predicts treatment response and prognosis in metastatic breast cancer: A prospective study in 393 patients[J]. BMC Cancer, 2014, 14: 512.
[10]
Jansson S, Bendahl PO, Larsson AM, et al. Prognostic impact of circulating tumor cell apoptosis and clusters in serial blood samples from patients with metastatic breast cancer in a prospective observational cohort[J]. BMC Cancer, 2016, 16: 433.
[11]
Molloy TJ, Devriese LA, Helgason HH, et al. A multimarker QPCR-based platform for the detection of circulating tumour cells in patients with early-stage breast cancer[J]. Br J Cancer, 2011, 104(12): 1913-1919.
[12]
Saloustros E, Perraki M, Apostolaki S, et al. Cytokeratin-19mRNA-positive circulating tumor cells during follow-up of patients with operable breast cancer: prognostic relevance for late relapse[J]. Breast Cancer Res, 2011, 13(3): R60.
[13]
Liu Y, Liu Q, Wang T, et al. Circulating tumor cells in HER2-positive metastatic breast cancer patients: A valuable prognostic and predictive biomarker[J]. BMC Cancer, 2013, 13: 202.
[14]
Liu MC, Shields PG, Warren RD, et al. Circulating tumor cells: A useful predictor of treatment efficacy in metastatic breast cancer[J]. J Clin Oncol, 2009, 27(31): 5153-5159.
[15]
Nakamura S, Yagata H, Ohno S, et al. Multi-center study evaluating circulating tumor cells as a surrogate for response to treatment and overall survival in metastatic breast cancer[J]. Breast Cancer, 2010, 17(3): 199-204.
[16]
盖希，范凤凤，李占文. 循环肿瘤细胞检测在乳腺癌预后评估中的作用及与乳腺癌分子分型的关系[J]. 浙江医学, 2018, 40(2): 202-205.
[17]
Chikaishi Y, Yoneda K, Ohnaga T, et al. EpCAM-independent capture of circulating tumor cells with a 'universal CTC-chip’[J]. Oncol Rep, 2017, 37(1): 77-82.
[18]
Bidard FC, Peeters DJ, Fehm T, et al. Clinical validity of circulating tumour cells in patients with metastatic breast cancer: A pooled analysis of individual patient data[J]. Lancet Oncol, 2014, 15(4): 406-414.
[19]
Pierga JY, Hajage D, Bachelot T, et al. High independent prognostic and predictive value of circulating tumor cells compared with serum tumor markers in a large prospective trial in first-line chemotherapy for metastatic breast cancer patients[J]. Ann Oncol, 2012, 23(3): 618-624.
[20]
王苗. 外周血循环肿瘤细胞和肿瘤标志物在监测转移性乳腺癌治疗及预后中的价值[J]. 实用癌症杂志, 2019, 34(1): 79-81.
[1] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(06): 563-570.
[2] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(06): 571-579.
[3] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[4] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[5] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[6] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[7] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[8] 王玲艳, 高春晖, 冯雪园, 崔鑫淼, 刘欢, 赵文明, 张金库. 循环肿瘤细胞在乳腺癌新辅助及术后辅助治疗中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 630-633.
[9] 赵林娟, 吕婕, 王文胜, 马德茂, 侯涛. 超声引导下染色剂标记切缘的梭柱型和圆柱型保乳区段切除术的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 634-637.
[10] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[11] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[12] 石阳, 于剑锋, 曹可, 翟志伟, 叶春祥, 王振军, 韩加刚. 可扩张金属支架置入联合新辅助化疗治疗完全梗阻性左半结肠癌围手术期并发症分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 464-471.
[13] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[14] 张颖, 赵鑫, 陈佳梅, 李雁. 术前化疗对CRS+HIPEC 治疗腹膜假黏液瘤预后影响的meta 分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 826-835.
[15] 蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号