非小细胞肺癌根治性化放疗前后外周血微转移的检测及其预后

目的探讨根治性化放疗治疗非小细胞肺癌（NSCLC）患者外周血微转移的预后意义。方法应用巢式CK19 RT-PCR方法,动态检测67例NSCLC患者根治性化放疗前后外周血微转移,研究其与临床病理特征的相关性和预后价值。结果治疗前和治疗后,微转移阳性分别为44例（65．7％）和22例（32．8％）;治疗前,微转移表达与N分期（P=0．014）相关;治疗后,微转移表达与N分期（P=0．032）、病理类型（P=0．019）、体重减轻（P=0．01）和KPS评分（P=0．027）相关;治疗前微转移阳性和阴性的4年远处转移率分别为78．3％和70．4％（P=0．544）,治疗后分别为100％和62．9％（P〈0．001）。治疗前微转移阳性和阴性患者的中位生存期分别为13．8个月和17．6个月, 4年生存率分别为18．2％和17．4％（P=0．619）。治疗后微转移阳性和阴性患者的中位生存期分别为7．8个月和27．6个月,4年生存率分别为0和26．4％（P〈0．001）。多因素分析显示,治疗后微转移阳性是一独立不良预后因素（P=0．000）。结论根治性化放疗后,外周血微转移的检测有预后价值;与微转移阳性相比,阴性患者预后好。

Detection and prognostic significance of micrometastasis in peripheral blood of patients with non-small cell lung cancer treated by chemo-radiation therapy

Objective To investigate the prognostic significance of micrometastasis (MM) in peripheral blood of patients with non-small cell lung cancer(NSCLC) treated by chemo-radiation therapy. Methods Peripheral blood was taken from 67 NSCLC patients before and after definitive chemo-radiation therapy. CK19 mRNA of the peripheral blood was measured by nested RT-PCR and both their relationship with clinicopathological features and prognostic significance were further investigated. Results The micrometastasis-positive rates were 65.7% (44/67) and 32. 8% (22/67), respectively, before and after the treatment. The micrometastasis-positive rate before treatment was closely in correlation with N-stage(P = 0.014). In contrast, it turned out to be more closely related with histological types(P = 0.019) , weight loss(P=0.01), KPS status(P=0.027) as well as N-stage(P =0.032) after chemo-radiation therapy. 4-yr distant metastasis rates(DMR)for micrometastasis-positive and -negative patients were 78.3% and 70.4% , respectively, before the treatment(P = 0. 544) while they were 100% and 62.9% , respectively, after the chemoradiation (P <0.001). The median survival time(MST) and 4-yr overall survival rate(OSR) for pre-treatment micrometastasis-positive and -negative patients were 13.8 months and 17.6 months, and 18.2% and 17. 4% , respectively (P = 0. 619), while for post-treatment micrometastasis-positive and -negative patients they were 7. 8 months and 27.6 months and 0 and 26.4% , respectively(P <0. 001). Multivariate analysis showed that the post-treatment positive micrometastasis was an independent unfavorable prognostic factor(P = 0.000). Conclusion detection of micrometastasis in peripheral blood may possess a prognostic significance after definitive chemo-radiation therapy. Micrometastasis-negative patients have better prognosis compared to those with positive micrometastasis.