| 摘要: |
| ［摘要］ 目的 探讨直肠癌患者围手术期外周血循环肿瘤细胞（CTCs）的变化情况及其对患者预后的影响。方法 选择2015-09～2016-12广西壮族自治区人民医院胃肠外科收治的直肠癌患者30例，采用随机数字表法将其分为腹腔镜手术组和开腹手术组，每组15例。采用CanpatrolTM 2代技术对患者手术前后的外周血CTCs进行分型检测。术后随访22～33个月，分析两组患者手术前后的CTCs水平变化，术前各分型CTCs与疾病特征的关联性以及手术前后CTCs对患者预后的影响。结果 腹腔镜手术组术后总CTCs水平较术前显著降低（P<0.05）。腹腔镜手术组术前混合型CTCs水平显著高于开腹手术组（P<0.05），但术后两组差异无统计学意义（P>0.05）。两组手术前后间质型CTCs和上皮型CTCs水平比较差异均无统计学意义（P>0.05），且同组手术前后比较差异亦无统计学意义（P>0.05）。间质型阴性组肿瘤直径≤3 cm的人数比例显著高于间质型阳性组（P<0.05）。术前总CTCs、混合型CTCs、上皮型CTCs情况与患者年龄、性别、T分期、N分期及肿瘤直径的关联性不显著（P>0.05）。3例术后CTCs阴性者在随访过程中均未发生死亡；27例术后CTCs 阳性者在随访过程中出现死亡4例，术后CTCs阴性者的生存情况显著优于阳性者（log-rank检验： χ2=6.553，P=0.031）。2例术前CTCs阴性者在随访过程中均未死亡，28例术前CTCs阳性者在随访过程中出现死亡4例，术前CTCs阴性者的生存情况显著优于阳性者（log-rank检验： χ2=5.245，P=0.027）。结论 外周血CTCs可用于直肠癌患者预后评价，指导临床治疗。 |
| 关键词: 直肠癌 循环肿瘤细胞 腹腔镜 开腹 |
| DOI：10.3969/j.issn.1674-3806.2020.12.11 |
| 分类号:R 735 |
| 基金项目:广西医疗卫生适宜技术开发与推广应用项目（编号：S201642）；广西卫健委科研项目（编号：Z20180700）；广西科技计划项目（编号：桂科AD17129027） |
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| Perioperative changes and clinical significance of circulating tumor cells in peripheral blood of patients with rectal cancer |
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HAN Ya-min, YIN Wu, WEI Bin, et al.
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Department of General Surgery, Xuzhou First People′s Hospital, Jiangsu 221002, China
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| Abstract: |
| ［Abstract］ Objective To explore the changes of circulating tumor cells(CTCs) in peripheral blood of the patients with rectal cancer during the perioperative period and its influence on the patients′prognosis. Methods Thirty patients with rectal cancer admitted to the Department of Gastrointestinal Surgery, the People′s Hospital of Guangxi Zhuang Autonomous Region were selected from September 2015 to December 2016, and were divided into laparoscopic surgery group and laparotomy group by random number table method, with 15 cases in each group. The classification and detection of CTCs in peripheral blood of the patients with rectal cancer were performed using CanpatrolTM 2nd generation technology before and after surgery. The patients were followed up for 22-33 months to analyze the changes of CTCs levels before and after surgery in the two groups. The correlation between each type of CTCs before surgery and disease characteristics, and the impacts of CTCs on the prognosis of the patients before and after surgery were analyzed. Results The level of total CTCs in the laparoscopic surgery group after surgery was significantly lower than that before surgery(P<0.05). The level of mixed type CTCs in the laparoscopic surgery group was significantly higher than that in the laparotomy group before surgery(P<0.05), but there was no statistically significant difference between the two groups after surgery(P>0.05). There were no statistically significant differences in the levels of interstitial type CTCs and epithelial type CTCs between the two groups before and after surgery(P>0.05), and there were no significant differences in the same group before and after surgery(P>0.05). The proportion of the patients with tumor diameter ≤3 cm in the interstitial type negative group was significantly higher than that in the interstitial type positive group(P<0.05). The preoperative total CTCs, mixed type CTCs, and epithelial type CTCs were not significantly correlated with the patients′ age, gender, T staging, N staging and tumor diameter(P>0.05). Three cases of postoperative CTCs negative patients did not die during the follow-up period, but among 27 cases of postoperative CTCs positive patients, 4 cases died during the follow-up period. The survival of the postoperative CTCs negative patients was significantly better than that of the positive patients(log-rank test: χ2=6.553, P=0.031). Two patients with negative CTCs before surgery did not die during the follow-up period, but 4 of 28 patients with positive CTCs before surgery died during the follow-up period. The survival of the preoperative CTCs negative patients was significantly better than that of the preoperative CTCs positive patients(log-rank test: χ2=5.245, P=0.027). Conclusion Peripheral blood CTCs can be used to evaluate the prognosis of the patients with rectal cancer and guide the clinical treatment. |
| Key words: Rectal cancer Circulating tumor cells(CTCs) Laparoscope Laparotomy |
