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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:
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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]. 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]. 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
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