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目的:探讨晚期卵巢癌患者外周血中循环肿瘤细胞(CTC)的检测及其临床意义。方法:选择2014年6月至2016年6月永州市中心医院收治的60例晚期卵巢癌患者作为观察组,收集同期本院的30例健康志愿者作为对照组。分别抽取外周血7.5 ml,采用流式细胞仪检测卵巢癌患者一线方案化疗2周期前后及对照组外周血中Ep CAM、CK19同时(+)且CD45(-)的CTC的变化情况,同时分析其与临床特征及化学疗效的关系以及比较化疗前后CTC数目评价与RECIST疗效评价标准之间的关系,并随访患者的无进展生存期(PFS),分析患者治疗过程中CTC数目的变化与患者PFS的关系。结果:观察组中42例检测到CTC,阳性率70%,对照组未检测到CTC,两组比较,差异具有统计学意义(P<0.05)。CTC阳性表达情况与卵巢癌患者的分化程度及CA125表达相关(P<0.05),与患者的年龄、肿瘤直径、腹水情况均无相关性(P>0.05)。观察组中化疗前CTC阳性表达42例,阳性率为70%,化疗2周期后卵巢癌患者CTC阳性表达18例,阳性率为30%,两组差异具有统计学意义(P<0.05)。化疗2周期后,CTC数目评价与RECIST疗效评价标准之间差异无统计学意义(P>0.05),且两种方法的吻合度较高(k=0.479)。运用相关分析显示,CTC表达与化学疗效呈负相关(r=-0.223,P=0.009)。化疗2周期后外周血中循环肿瘤细胞数目<5,其无进展生存期为13.2(11.0~15.1)个月,外周血中循环肿瘤细胞数目≥5,其无进展生存期为6.4(3.8~9.2)个月,两组差异具有统计学意义(P<0.05)。结论:CTC阳性表达与卵巢癌患者的分化程度及CA125表达相关,与化疗疗效呈负相关,CTC的表达情况可以预测卵巢癌患者的化疗疗效及预后。
Objective: To investigate the detection of circulating tumor cells (CTCs) in peripheral blood of patients with advanced ovarian cancer and its clinical significance. Methods: Sixty patients with advanced ovarian cancer who were admitted to Yongzhou Central Hospital from June 2014 to June 2016 were selected as the observation group. Thirty healthy volunteers in our hospital were selected as the control group. The blood samples were collected from peripheral blood of 7.5 ml. The changes of EpCam, CK19 (+) and CD45 (-) CTC in the peripheral blood of patients with ovarian cancer before and after 2 cycles of chemotherapy were analyzed by flow cytometry. The relationship between CTC number before and after chemotherapy and the evaluation criteria of RECIST was compared with the clinical characteristics and chemotherapeutic efficacy. The progression-free survival (PFS) of patients were followed up. The changes of CTC number in patients during treatment were compared with those of patients with PFS relationship. Results: The positive rate of CTC was detected in 42 cases in observation group and 70% in control group. CTC was not detected in control group. The difference was statistically significant (P <0.05). The positive expression of CTC was correlated with the differentiation of patients with ovarian cancer and the expression of CA125 (P <0.05), but not with the age, tumor diameter and ascites (P> 0.05). In the observation group, there were 42 positive cases of CTC before chemotherapy, the positive rate was 70%. The positive expression rate of CTC was 18% in ovarian cancer patients after 2 cycles of chemotherapy. The positive rate was 30%. There was significant difference between the two groups (P <0.05). After 2 cycles of chemotherapy, there was no significant difference between CTC number evaluation and RECIST evaluation standard (P> 0.05), and the two methods had good agreement (k = 0.479). Correlation analysis showed that the expression of CTC was negatively correlated with chemotherapy (r = -0.223, P = 0.009). After 2 cycles of chemotherapy, the number of circulating tumor cells in the peripheral blood was less than 5, and the progression-free survival was 13.2 (11.0-15.1) months. The number of circulating tumor cells in the peripheral blood was more than 5 and the progression-free survival was 6.4 (3.8-9.2) ) Months, the difference between the two groups was statistically significant (P <0.05). Conclusion: The positive expression of CTC is correlated with the differentiation degree of patients with ovarian cancer and the expression of CA125, and negatively correlated with the curative effect of chemotherapy. The expression of CTC can predict the chemotherapy efficacy and prognosis of patients with ovarian cancer.