摘要
目的分析循环肿瘤细胞(CTCs)在中晚期非小细胞肺癌(NSCLC)患者化疗联合分子靶向治疗过程中的疗效评价能力。方法采用回顾性研究方法,选取2014年8月至2018年2月河北省涿州市医院收治的采用吉西他滨加顺铂(GP)化疗、联合吉非替尼靶向治疗的中晚期NSCLC患者共33例,共观察4个疗程。分别于治疗前,以及治疗2、4个疗程后按照实体肿瘤疗效评价标准(RECIST)检测肿瘤直径及肿瘤标志物变化;并通过免疫磁珠法富集、Envision法检测外周血CTCs的变化,分析CTCs标准与RECIST标准的异同。结果联合治疗前,33例中晚期NSCLC患者均检测出CTCs,检测阳性率为100%,而基线CTCs数量在不同年龄、性别、肿瘤类型和临床分期和吸烟史患者间差异无统计学意义(P>0.05);而肿瘤直径越大,CTCs数量越多(P<0.05)。Spearman相关性分析显示,第2疗程后CTCs变化与治疗效果具有相关性(r=0.832,P=0.000)。按照RECIST标准分为有效组(n=19)和无效组(n=14),有效组治疗第2疗程和第4疗程后CTCs计数分别为8.0(3.0,15.0)个/5 ml及5.0(3.0,10.0)个/5 ml与治疗前12.0(7.0,18.0)个/5ml相比,差异均具有统计学意义(Z=-3.427、-3.876,P<0.05);无效组治疗第2疗程和第4疗程后CTCs计数分别为16.5(12.0,20.0)个/5 ml,18.5(14.0,22.0)个/5 ml与联合治疗前14.5(10.0,18.0)个/5 ml相比,差异均具有统计学(Z=-3.126、-2.897,P<0.05)。采用Fisher’s确切概率法评价两种疗效判定方法,两者差异无统计学意义(P>0.05)。结论中晚期NSCLC联合治疗过程中,CTCs测定可以实现早期、有效的疗效评价,是RECIST标准的有益补充。
Objective To analyze the role of circulating tumor cells(CTCs)in the efficacy evaluation of chemotherapy combined with molecular targeted therapy in patients with advanced non-small cell lung cancer(NSCLC).Methods 33 patients with advanced NSCLC who were treated with gemcitabine plus cisplatin(GP)chemotherapy and gefitinib in the Cangzhou Hospital of Hebei Province from August 2014 to February 2018 were enrolled in this retrospective study.A total of 4 courses of treatment were observed.Tumor diameters before treatment,after the second course and the fourth course of treatments were measured according to the Response Evaluation Criteria in Solid Tumors(RECIST),and the changes of tumor markers were also recorded.The changes of peripheral blood CTCs were detected by immunomagnetic beads and Envision method.The similarities and differences between the CTCs standard and the RECIST standard were analyzed.Results Before the combination therapy,33 patients with advanced NSCLC were detected with CTCs,and the positive rate was 100%.There was no significant difference in the number of baseline CTCs among patients of different ages,genders,tumor types,clinical stages and smoking history(P>0.05).The larger the tumor diameter,the greater the number of CTCs(P<0.05).Spearman correlation analysis showed that the change in CTCs after the second course of treatment was correlated with the treatment effect(r=0.832,P=0.000).According to the RECIST criteria,patients were divided into the effective group(n=19)and the ineffective group(n=14).The number of CTCs in the effective group treatment after the second course and the fourth course of treatment were 8.0(3.0,15.0)/5 ml and 5.0(3.0,10.0)/5 ml respectively,compared with 12.0(7.0,18.0)/5 ml before treatment,and the differences were statistically significant(Z=-3.427,-3.876,P<0.05).The number of CTCs in the ineffective group after the second course and the fourth course of treatment were 16.5(12.0,20.0)/5 ml,18.5(14.0,22.0)/5 ml respectively,compared with 14.5(10.0,18.0)/5 ml before t
作者
胡亚锋
屈志刚
李金波
伍光
田彦
HU Ya-feng;QU Zhi-gang;LI Jin-bo(Department of Cardiothoracic Surgery,Zhuozhou Hospital,Baoding Hebei 072750,China)
出处
《临床和实验医学杂志》
2020年第2期173-176,共4页
Journal of Clinical and Experimental Medicine
基金
河北省保定市科技支撑计划(编号:17zf293)
