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目的探讨早期乳腺癌(EBC)患者手术对循环肿瘤细胞(CTC)的影响。方法选取2008年1月至2015年1月间山东省临沂市沂水中心医院收治的134例EBC患者。所有患者均接受根治术或保乳切除术。比较134例EBC患者的肿块体积大小、淋巴结转移、人类表皮生长因子受体2(HER-2)、激素受体和组织学分级等与循环肿瘤细胞(CTC)检出率和检出数量的关系。分析手术前后患者CTC检出率和检出数量。结果 EBC患者肿块体积大小、淋巴结转移、激素受体和组织学分级等与CTC检出率和检出数量间差异无统计学意义(P>0.05)。CTC检测水平仅与HER-2表达有关,HER-2阳性患者CTC检出率明显高于HER-2阴性患者,差异有统计学意义(P<0.05)。HER-2阳性患者与HER-2阴性患者CTC检出数量方面差异无统计学意义(P>0.05)。EBC患者手术前、手术后3~4 d、手术后7~8 d和手术后20~30 d(首次化疗前)CTC检出率分别为35.8%、53.7%、37.3%和36.6%,CTC检出数量分别为(2.2±1.5)个、(5.6±2.1)个、(3.5±1.7)个和(2.3±1.4)个。手术后3~4 d CTC水平比较手术前明显升高,差异有统计学意义(2=5.815,P<0.05)。手术后7~8 d降至术前水平,差异无统计学意义(P>0.05)。首次化疗前,CTC仍维持在手术前水平,差异无统计学意义(P>0.05)。结论 CTC水平与EBC患者HER-2的表达明显相关,CTC检测可作为预测乳腺癌患者治疗反应的一个重要指标。
Objective To investigate the effect of surgery on circulating tumor cells (CTC) in patients with early stage breast cancer (EBC). Methods Totally 134 EBC patients admitted from January 2008 to January 2015 in Yishui Central Hospital of Linyi City, Shandong Province were enrolled. All patients underwent radical surgery or breast-conserving resection. The relationship between volume and size of lymph nodes, lymph node metastasis, HER-2, hormone receptor and histological grade in 134 EBC patients was compared with that of circulating tumor cells (CTCs) . Analysis before and after surgery in patients with CTC detection rate and the number of detected. Results There was no significant difference in the detection rate of CTC and the number of detected CTCs in patients with EBC (P> 0.05), such as tumor size, lymph node metastasis, hormone receptor and histological grade. The detection of CTC was only related to the expression of HER-2, and the positive rate of CTC in HER-2 positive patients was significantly higher than that in HER-2 negative patients (P <0.05). The number of CTC detected in HER-2 positive patients and HER-2 negative patients was not statistically different (P> 0.05). The CTC detection rate was 35.8%, 53.7%, 37.3% and 36.6% respectively before operation, 3 ~ 4 days after operation, 7 ~ 8 days after operation and 20 ~ 30 days after operation (before first chemotherapy) The numbers were (2.2 ± 1.5), (5.6 ± 2.1), (3.5 ± 1.7) and (2.3 ± 1.4), respectively. The level of CTC in 3 ~ 4 days after operation was significantly higher than that before operation (2 = 5.815, P <0.05). There was no significant difference between the 7th and 8th day after surgery (P> 0.05). Before the first chemotherapy, CTC remained at the level of preoperative, the difference was not statistically significant (P> 0.05). Conclusion The CTC level is significantly correlated with the expression of HER-2 in patients with EBC. CTC test can be used as an important index in predicting the response of patients with breast cancer.