循环肿瘤细胞在晚期食管鳞癌患者疗效评估中的临床价值*

Clinical value of circulating tumor cells in evaluating the efficacy of patients with advanced esophageal squamous cell carcinoma*

摘要:

目的 探究循环肿瘤细胞（CTC）在评估晚期食管鳞癌患者同步放化疗疗效的临床应用。方法 选取2015年12月31日—2016年12月31日安徽医科大学第一附属医院肿瘤放疗科的食管鳞癌晚期患者（Ⅲ、Ⅳ期）38例，予以50?Gy的三维适行放疗联合TP方案（紫杉醇135?mg/m2；顺铂25?mg/m2）化疗，在放化疗前采集患者的外周血检测CTC，并对患者进行2年密切随访，运用t检验，Z检验分析CTC值变化，Kaplan-Meier方法及Log-rank χ2检验分析患者CTC值与生存率的关系，并运用Cox回归模型进行多因素分析。结果 食管鳞癌患者同步放化疗后肿瘤直径较治疗前明显减小，同步放化疗前后CTC差值（dCTC）、CEA的差值（dCEA）、CA199的差值（dCA199）、放疗前CA125值对患者预后有影响，dCTC和放疗前CA125值是评估入组患者预后的独立影响因素。结论 对食管癌同步放化疗的患者，放疗前后CTC的差值，放疗前CA125值相比较放疗前CTC、CEA及CA199值，能更好地评估患者的预后。

Abstract:

Objective To investigate the clinical application of circulating tumor cells (CTCs) in evaluating the efficacy of concurrent chemoradiotherapy in patients with advanced esophageal squamous cell carcinoma. Methods Thirty eight patients with advanced (III, IV) esophageal squamous cell carcinoma were enrolled in this study. 50?Gy three-dimensional radiotherapy combined with TP regimen (paclitaxel 135?mg/m2 d1; cisplatin 25?mg/m2 d1-3) was given. Peripheral blood samples were collected from patients before chemotherapy, and the 38 patients with esophageal cancer were followed closely for 2 years. The t-test and z-test were used to analyze the change of CTC value. Kaplan-Meier method, Log rank test and Cox regression methods were used to analyze the relationship between CTC value and survival rate of patients. Results The tumor diameter value of patients with esophageal squamous cell carcinoma was significantly reduced compared with the previous. The differences of CTC (dCTC), CEA (dCEA), CA199 (dCA199) and CA125 value before and after radiotherapy and CA 125 before radiotherapy affected the prognosis of patients. dCTC and pre-radiation CA125 values were independent factors influencing the prognosis of enrolled patients. Conclusion For patients with concurrent chemoradiotherapy for esophageal cancer, compared with CTC before radiotherapy, CEA and CA199, the difference of CTC before and after radiotherapy and CA125 before radiotherapy are superior indexes to evaluate the prognosis of patients.