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目的联合检测肺腺癌患者外周血中细胞角蛋白(cytokeratin,CK,肺腺癌循环肿瘤细胞阳性)和CD133基因(肺癌干细胞标志物)的表达,探讨二者在评估肺腺癌预后的临床价值。方法选取2014年6月至2016年6月昆明总医院心胸外科和宣威市第一人民医院心胸外科的178例未化疗的肺腺癌手术患者,中位年龄59岁,其中男性78例,女性100例。收集患者术前外周血标本10 m L,细胞块法和CK(免疫细胞化学法)用于检测CTC,PCR法用于检测CD133表达。免疫组化法检测肺腺癌组织中CK、Vimentin(Vim)、TTF-1、Ki-67、CD133的表达,并分析与外周血CK和CD133表达的关系。根据外周血CK和CD133的检测结果,将病例分为CK/CD133双阳性组和非双阳性组,统计学分析两组间临床病理因素的差异。结果 178例肺腺癌患者外周血CTC(CK阳性)的检出率为48.3%(86/178),与癌组织中Ki-67、Vim表达显著正相关(P<0.05);外周血的CD133阳性表达率为66.9%(119/178),与癌组织Vim、CD133表达显著正相关(P<0.05);外周血CK/CD133双阳组53例(29.8%),双阳组淋巴结转移率显著增高,肺腺癌组织学分化级别显著降低,临床分期显著提高,转移率显著增高(P<0.05)。结论肺腺癌患者外周血中CK与CD133双阳性表达提示外周血存在干性特征的循环肿瘤细胞,表明预后不良,联合检测CK与CD133可用于肺腺癌患者预后监测和指导治疗。
Objective To detect the expression of cytokeratin (CK), circulating tumor cells of lung adenocarcinoma and CD133 gene (lung cancer stem cell marker) in peripheral blood of patients with lung adenocarcinoma and to explore the clinical value of the two in assessing the prognosis of lung adenocarcinoma . Methods From June 2014 to June 2016, 178 patients with non-chemotherapy lung adenocarcinoma who underwent cardiothoracic surgery at the General Hospital of Kunming General Hospital and the First People’s Hospital of Xuanwei City were selected. The median age was 59 years. There were 78 males and 78 females 100 cases. Preoperative peripheral blood samples were collected 10 m L, cell mass method and CK (immunocytochemistry) for the detection of CTC, PCR method for the detection of CD133 expression. The expressions of CK, Vimentin (Vim), TTF-1, Ki-67 and CD133 in lung adenocarcinoma were detected by immunohistochemistry. The relationship between the expression of CK and CD133 in peripheral blood was also analyzed. According to the detection results of peripheral blood CK and CD133, the patients were divided into positive and negative CK / CD133 groups, and the differences between the two groups were statistically analyzed. Results The positive rate of CTC (CK positive) in peripheral blood of 178 patients with lung adenocarcinoma was 48.3% (86/178), which was positively correlated with the expression of Ki-67 and Vim in cancer tissue (P <0.05) (119/178), which was positively correlated with the expression of Vim and CD133 in cancer tissues (P <0.05). The positive rate of lymph node metastasis in Shuangyang group was significantly higher than that in CK / CD133 Shuangyang group (53 cases, 29.8% Lung adenocarcinoma histological differentiation significantly reduced the level of clinical stage was significantly improved, the transfer rate was significantly higher (P <0.05). Conclusions Double positive expression of CK and CD133 in peripheral blood of patients with lung adenocarcinoma suggests that there are dry circulating tumor cells in peripheral blood, indicating that the prognosis is poor. Combined detection of CK and CD133 may be used to monitor and guide the prognosis of patients with lung adenocarcinoma.