CTCs在膀胱癌转移及预后评估中应用的研究

目的 检测膀胱癌患者外周血循环肿瘤细胞(circulating tumor cells, CTCs)的计数及分型,研究其在膀胱癌的转移及预后评估中的临床应用价值. 方法 采用CanPatrolTM二代CTCs检测技术检测外周血CTCs计数及分型.41例经病理确诊的膀胱癌患者纳入研究,患者年龄33~83岁,男37例,女4例.肿瘤TNM分期:T1期15例、T2期12例、T3期9例、T4期5例、N1期6例、M1期3例.肿瘤组织病理分级:高级别膀胱癌30例、低级别膀胱癌11例. 结果 41例膀胱癌患者总CTCs阳性率为68.29%(28/41),6例淋巴结转移患者中检出CTCs阳性2例,3例远处转移患者中检出CTCs阳性1例.本研究共检出CTCs 136个,其中上皮型CTCs 36个(26.5%)、混合型CTCs 70个(51.5%)、间质型CTCs 30个(22.0%);间质化CTCs 100个,占73.5%.30例高级别膀胱癌中CTCs检出20例,占66.7%,11例低级别膀胱癌中CTCs检出7例,占63.6%.13例CTCs阴性患者中,无淋巴结转移10例(69.23%),淋巴结转移3例(30.76%).T1G3患者间质型CTCs阳性率为60.0%,CTCs总数≥3的患者比例为60.0%;T1G1~2患者间质型CTCs阳性率为20.0%,CTCs总数≥3的患者比例为20.0%.41例中29例患者术后获得随访,随访12~41个月,平均(13±2)个月,死亡8例.术后总生存率为72.41%,其中CTCs阳性者生存率为77.77%(14/18),CTCs阴性者生存率为63.60%(7/11). 结论 T1G3患者的间质型CTCs阳性率及CTCs总数≥3的患者比例明显高于T1G1~2患者.CTCs的总数及间质型CTCs的个数能够在一定程度上预测膀胱癌的恶性程度,并指导非肌层浸润性膀胱癌患者的早期治疗.CTCs的阳性检出率与膀胱癌的TNM分期、淋巴结转移、近期生存率之间未发现有明显相关性.

Clinical application of CTCs in the evaluation of bladder cancer metastasis and prognosis

Objective To detect circulating tumor cells (CTCs) and its types from peripheral blood in bladder cancer patients, and discuss TNM classification and its prognostic evaluation in clinical applications.Methods 41 patients, 37 males and 4 females, were pathologically diagnosed as bladder cancer and their ages ranged from 33 to 83.CanPatrolTM second-generation technology was used to detect CTCs in peripheral blood.Tumor TNM staging: T1 in 15 cases;T2 in 12 cases;T3 in 9 cases;T4 in 5 cases;N1 in 6 cases;M1 in 3 cases.Tumor pathology classification: high-grade bladder cancer in 30 cases;low-grade bladder cancer in 11 cases.Results Of all 41 cases 68.29% (28/41) was positive for CTCs.2 out of 6 cases of lymph node metastasis were CTCs positive, 1 out of 3 cases with distant metastasis was CTCs positive.Of 30 cases of high-grade bladder cancer 20 cases were CTCs positive (66.7%), of 11 cases of low-grade bladder cancer 7 cases were CTCs positive (63.6%).Of 13 patients who were CTCs negative, 10 patients have no lymph node metastases (69.23%), and 3 patients with lymph node metastasis (30.76%).In T1G3 patients, the positive rate of interstitial CTCs was 60%, the total number of CTCs≥3 in patients with positive rate: 60%.In T1G1~2 (high-moderately differentiated) patients, the positive rate of interstitial CTCs was 20%, the total number of CTCs≥3 in patients with positive rate: 20%.29 patients were followed up 12 to 41 months, an average of (13±2)months, 8 cases died.The overall survival rate was 72.41%.The positive survival rate of CTCs was 77.77% (14/18), the negative survival rate of CTCs was 63.6% (7/11).Conclusions The positive rate of interstitial CTCs and the total number of CTCs in patients with T1G3 was significantly higher than those in T1G1~2 patients.The total number of CTCs and the number of interstitial CTCs can predict the degree of malignancy of bladder cancer to a certain extent and guide the early treatment of patients with non-invasive bladder cancer.There was no significant correlation between the positive rate of CTCs and the TNM staging, lymph node metastasis and short-term survival rate of bladder cancer.