脑胶质瘤脑脊液循环肿瘤细胞监测的临床意义

目的探讨脑胶质瘤脑脊液循环肿瘤细胞监测的临床意义。方法选取内蒙古自治区人民医院神经外科2017年1月至2020年1月收治脑胶质瘤患者60例,均行外科手术治疗。采用免疫荧光原位杂交技术(FISH)法检测循环肿瘤细胞(CTC)。比较术前、术后14 d和术后3个月CTC阳性率;不同病理特征CTC阳性率;不同预后CTC阳性率。采用Kaplan-Meier法计算9~45个月患者生存率并绘制生存分析函数曲线。采用Cox回归模型对患者预后因素进行多因素分析,探讨影响脑胶质瘤术后患者生存的因素。结果术后14 d和术后3个月CTC阳性率低于术前(F=3.315,P<0.05),差异有统计学意义;术后3个月CTC阳性率低于术后14 d(χ2=5.714,P<0.05),差异有统计学意义。不同性别、年龄和体重指数CTC阳性率比较差异无统计学意义(χ2=2.000、1.047、0.012,P>0.05);Ⅲ~Ⅳ级CTC阳性率阳性率高于Ⅰ~Ⅱ级(χ2=15.227,P<0.05),差异有统计学意义。纳入60例患者随访9~45个月,随访时间(24.63±6.97)个月,总生存时间(21.87±4.56)个月,随访末预后良好19例、预后不良41例。预后不良组CTC阳性率(85.37%)高于预后良好组(15.79%)(χ2=27.065,P<0.05),差异有统计学意义。经多因素Cox比例风险回归分析显示,病理分级和CTC阳性为影响脑胶质瘤患者预后不良危险因素。结论脑脊液CTC在脑胶质瘤中呈高表达,且与病理分级和预后密切相关,为影响预后危险因素。

Clinical significance of monitoring tumor cells in cerebrospinal fluid circulation of gliomas

Objective To investigate the clinical significance of tumor cell monitoring in cerebrospinal fluid(CSF)circulation of gliomas.Methods A total of 60 patients with gliomas in the Department of Neurosurgery of the People’s Hospital of Inner Mongolia Autonomous Region from January 2017 to January 2020 were selected.The circulating tumor cells(CTCs)were detected by immunofish.The positive rates of CTCs before operation,14 days after operation and 3 months after operation,the positive rates of CTCs with different pathological characteristics and different prognosis were compared.The survival rate of patients from 9 months to 45 months was calculated by Kaplan-Meier method and the survival analysis function curve was drawn.Cox regression model was used to analyze the prognostic factors of patients with glioma,and to explore the factors affecting the survival of postoperative glioma patients.Results The positive rate of CTCs at 14 days and 3 months after operation was lower than before operation(F=3.315,P<0.05).The positive rate of CTCs at 3 months after operation was lower at 14 days after operation than before operation(χ2=5.714,P<0.05).There was no significant difference in the positive rate of CTCs among different gender,age and body mass index(χ2=2.000,1.047,0.012,P>0.05).The positive rate of CTCs in gradeⅢ-Ⅳwas higher than in gradeⅠ-Ⅱ(χ2=15.227,P<0.05).The average follow-up time was(24.63±6.97)months and the average overall survival time was(21.87±4.56)months.At the end of follow-up,19 cases had good prognosis and 41 cases had poor prognosis.The positive rate of CTCs in poor prognosis group(85.37%)was higher than in good prognosis group(15.79%,χ2=27.065,P<0.05).Multivariate Cox proportional hazard regression analysis showed that pathological grade and positive CTCs were risk factors for poor prognosis of patients with glioma.Conclusion The CTCs in cerebrospinal fluid(CSF)of patients with glioma are highly expressed and are closely related to pathological grade and prognosis,which are the risk factor for prognosis.