摘要
目的探究老年晚期肺腺癌患者循环肿瘤细胞(CTC)与临床病理特点及预后的关系,为肺腺癌临床诊疗提供依据。方法本实验包含95例经病理确诊的晚期肺腺癌老年病例,化疗前1 d、化疗2个周期后均采集外周空腹肘静脉血,免疫磁珠法联合免疫荧光原位杂交法检测CTC,分析肺腺癌化疗前后CTC阳性率的变化;并采集所有肺腺癌病例临床病理资料,探究CTC阳性率与病理参数、疗效的关系;所有肺腺癌病例均随访至2019年6月,Kaplan-Meier法进行生存分析,比较不同CTC水平老年肺腺癌预后的差异,单因素及多因素分析筛选预后影响因素。结果化疗前腺癌患者CTC阳性率为65.26%,高于化疗2周期后的47.37%(P<0.05);CTC数目减少患者化疗效果等级优于CTC数目不变与增多患者(P<0.05);临床分期为Ⅳ期、病理分化程度为低分化、浸润范围为T3~T4、淋巴结转移为N3期、伴表皮生长因子受体(EGFR)基因突变肺腺癌患者血CTC阳性率高于临床分期为Ⅲ期、病理分化程度为中高分化、浸润范围为T1~T2、淋巴结转移为N0~N2期、不伴EGFR基因突变的患者(P<0.05);随访截止日老年肺腺癌患者累积疾病进展19例(20.00%),CTC阳性患者17例(27.42%,17/62),阴性2例(6.06%,2/33),CTC阳性、阴性患者随访截止日无进展生存率分别为72.58%(45/62)、93.94%(31/33),中位无进展生存时间分别为11.29个月与13.04个月,Log-Rank检验差异有统计学意义(P<0.05);多因素分析显示:临床分期、浸润范围、淋巴结转移、CTC、EGFR基因突变均为影响肺腺癌无进展生存期的相关因素(P<0.05)。结论老年晚期肺腺癌患者血CTC阳性率高,且与肺腺癌病理进展、肿瘤浸润范围、淋巴结转移、EGFR基因突变有关,或可能为预示不良预后的有效指标。
Objective To explore the relationship of circulating tumor cell(CTC)changes with clinicopathological features and prognosis of elderly patients with advanced lung adenocarcinoma(LA),and to provide evidence for clinical diagnosis and treatment of LA.Methods 95 elderly patients with advanced LA confirmed by pathology were enrolled in the experiment.Peripheral fasting elbow venous blood of the subjects was collected at 1 day before chemotherapy and after 2 cycles of chemotherapy.CTC were detected by magnetic activated cell sorting and fluorescence in situ hybridization.Changes of positive rates of CTC in patients with LA before and after chemotherapy were analyzed.The clinicopathological data of all patients with LA were collected.The relationship between positive rate of CTC and pathological parameters,curative effect was explored.All subjects were followed up till June 2019.Survival analysis was performed by Kaplan-Meier method.The prognosis was compared between elderly patients with LA and different CTC levels.Univariate analysis and multivariate analysis were performed to screen influencing factors of prognosis.Results The positive rate of CTC in patients with LA before chemotherapy was higher than that after 2 cycles of chemotherapy(65.26%vs 47.37%)(P<0.05).The grade of curative effect in patients with reduced CTC was better than that in patients with constant or increased CTC(P<0.05).The positive rate of CTC was higher in patients with LA at clinical stageⅣ,patients with low pathological differentiation,infiltrative range of T3~T4,lymph node metastasis at stage N3 and gene mutation of epidermal growth factor receptor(EGFR)than in patients at clinical stageⅢ,patients with moderate to high pathological differentiation,infiltrative range of T1-T2,lymph node metastasis at stage N 0-N 2 and patients without EGFR gene mutation(P<0.05).Till the end of the follow-up,there were 19 cases(20.00%)with cumulative disease progression,17 cases(27.42%,17/62)with positive CTC,and 2 cases(6.06%,2/33)with negative CTC.The progression-free survival rates of positive and negative CTC patients were 72.58%(45/62)and 93.94%(31/33),respectively.Their median progression-free survival time was 11.29 months and 13.04 months,respectively.Log-rank test showed that differences were statistically significant(P<0.05).Multivariate analysis showed that clinical staging,infiltrative range,lymph node metastasis,CTC and EGFR gene mutation were all related factors influencing progression-free survival of LA(P<0.05).Conclusion The positive rate of blood CTC is high in elderly patients with advanced LA,which is related to the pathological progression of LA,tumor infiltrative range,lymph node metastasis and EGFR gene mutation.They may be effective indexes for predicting poor prognosis.
作者
王玮
叶维洁
王玉树
张为强
WANG Wei;YE Wei-jie;WANG Yu-shu;ZHANG Wei-qiang(Department of Oncology,Shibei Hospital of Jing'an District,Shanghai 200435,China)
出处
《临床肺科杂志》
2020年第7期983-990,共8页
Journal of Clinical Pulmonary Medicine
关键词
肺腺癌
老年
循环肿瘤细胞
晚期
病理
生存
预后
lung adenocarcinoma
elderly
circulating tumor cell
advanced
pathology
survival
prognosis
