检测肝癌肝移植患者术前和术中肿瘤播散状况的临床意义

目的 探讨检测肝癌肝移植患者术前和术中肿瘤细胞播散状况的意义，观察其与肿瘤1年复发率和患者存活率的相关性。方法 2003年10月至2004年2月共为30例甲胎蛋白（AFP）阳性的肝癌患者进行肝移植，术前和术中取患者外周静脉血、外周动脉血、门静脉血和肺动脉血，采用逆转录-聚合酶链法（RT-PCR）联合荧光标记探针杂交法定量，检测血液中游离的肝癌细胞内特异AFP mRNA的表达，计算各部位血液的AFP mRNA阳性率及其拷贝数（1g值），统计患者1年肿瘤复发率及存活率。结果 30例肝癌肝移植患者术中外周静脉血、外周动脉血、门静脉血、肺动脉血中播散的肿瘤细胞内AFP mRNA阳性率与术前相比明显升高，且以肺动脉血最为敏感，阳性率为63．3％（P〈0．01）；在各相应部位的血液中，术中播散的肿瘤细胞内AFP mRNA拷贝数（1g值）也较术前明显升高（P〈0．05）；术前和术中肿瘤细胞播散的患者中，术后1年肿瘤复发率高，但患者的1年存活率与无肿瘤细胞播散者比较，差异无统计学意义（P〉0．05）。结论 RT-PCR联合荧光标记探针杂交法能够检测到肝癌患者血液中播散的肿瘤细胞，并且以肺动脉血中阳性率最高。肝移植手术操作过程中可以引起肿瘤细胞播散，其结果与肿瘤复发相关。

Clinical significance of detection of the disseminating tumor cell before and during liver transplantation of HCC

Objective To study the clinical significance of tumor cell disseminating before and during liver transplantation (LT) for hepatocellular carcinoma (HCC), and the relationship between disseminated tumor cells (DTC) and one-year recurrent rate, one-year survival rate. Methods From Oct. 2003 to Feb. 2004, 30 patients, positive for serum AFP, with HCC subject to LT were selected. Blood of periphery arterym, vein, portal vein and pulmonary artery was collected before and during operation. AFP mRNA in DTC was quantitated by fluorescence quantitative PCR combined with RT-PCR technique. One-year survival and recurrent rate was observed. Relationship was analyzed with x2 test and t test by Microsoft SPSS 9. 0. Results There was significant difference in the positive expression rate of DTC and AFP mRNA copy (lg) before and during operation (P<0. 01 and P<0. 05, respectively). Between tumor cell disseminating and non-tumor cell disseminating, there was significant difference in one-year recurrent rate before and during operation (P<0. 05), but there was no significant difference in one-year survival rate (P>0. 05). Conclusions Fluorescence quantitative PCR combined with RT-PCR technique can detect the DTC in blood of the patients with HCC. LT can result in the dissemination of tumor cells, which is related with one-year recurrent rate.