Abstract:

Detection and clinical significance of perioperative circulating tumor cells in patients with stage Ⅱto Ⅲ colorectal carcinoma        WANG Dong，JIN Lan，WANG Jin，et al. Department of General Surgery，Beijing Friendship Hospital，Capital Medical University，Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center of Digestive Diseases，Beijing 100050，China
Corresponding author：YANG Ying-chi，E-mail：yangyingchi2004@sina.com；DING Guo-qian，E-mail：dingguoqian@126.com
Abstract    Objective    To detect perioperative circulating tumor cells (CTCs) in patients with colorectal carcinoma and evaluate their clinical significance. Methods    A total of 69 patients with stage Ⅱto Ⅲ sporadic primary colorectal cancer were collected from Department of General Surgery，Beijing Friendship Hospital，Capital Medical University from June 2015 to August 2017. All the patients received surgery and no preoperative neoadjuvant therapy. Peripheral blood samples were collected before operation (Pre-OP)，on three days post-operation (POD3)，and one 14 days post-operation (POD 14). CTCs were detected using density-gradient centrifugation and immunofluorescence staining. Associations of perioperative CTCs with clinicopathological features and tumor recurrence were determined. Results  Average Pre-OP，POD3，and POD14 CTCs were (3.8±0.5) number/3.5 mL，(6.6±1.4) number/3.5 mL，and (3.5±0.5) number/3.5 mL，respectively. There was significant difference between POD3 and POD14 CTCs（P<0.05）. Pearson correlation analysis suggested that Pre-OP CTCs was significantly associated with POD14 CTCs (r=0.433，P<0.001). Association of POD14 CTCs with TNM stage was found (χ2=3.916，P=0.048) and there was a trend of association between POD3 CTCs with gender (χ2=3.857，P=0.050). The follow-up duration was 15.6（3.5-35.0） months and the recurrence rate of the patients was 10.6%（7/63）. Kaplan-Meier curves revealed no significant associations of tumor recurrence with POD3 CTCs (P=0.194) and POD14 CTCs (P=0.269). Conclusion    Compared with preoperative CTCs，postoperative CTCs are firstly increased and then decreased. The postoperative CTCs are potential biomarkers for colorectal cancer recurrence but needed to be verified in more studies.

Key words: colorectal carcinoma, circulating tumor cells, tumor recurrence

摘要：

目的    探究Ⅱ~Ⅲ期结直肠癌病人围手术期外周血循环肿瘤细胞（CTCs）检测及临床意义。方法    选择2015年6月至2017年8月首都医科大学附属北京友谊医院普外科行手术治疗的69例Ⅱ~Ⅲ期散发性初治结直肠癌病人，术前均未接受新辅助治疗。收集术前、术后3 d、术后14 d外周血，应用密度梯度离心法和免疫荧光法检测CTCs，比较手术前后CTCs数目变化。同时探讨不同时间CTCs数目与临床病理学指标和肿瘤复发的相关性。结果    术前CTCs数目平均为（3.8±0.5）个/3.5 mL，术后3 d为（6.6±1.4）个/3.5 mL，术后14 d为（3.5±0.5）个/3.5 mL。术后3 d与术后14 d CTCs数目差异有统计学意义（P<0.05）。相关性分析显示，术前与术后14 d CTCs数目具有相关性（r=0.433，P<0.001）。围手术期CTCs数目与临床病理特征相关性分析发现，术后14 d CTCs数目与TNM分期相关，Ⅲ期病人CTCs阳性率高于Ⅱ期病人（χ2=3.916，P=0.048）；术后3 d CTCs数目与性别呈一定的相关性趋势（χ2=3.857，P=0.050）。随访时间为15.6（3.5～35.0）个月，复发率为10.6%（7/63）。术后3 d CTCs数目（P=0.194）和术后14 d CTCs数目（P=0.269）与术后无复发生存时间相关性差异无统计学意义。结论    与术前比较，结直肠癌病人术后CTCs数目先升高后降低，其可能具有预测术后复发的潜在价值，但需进一步研究证实。

关键词: 结直肠癌, 循环肿瘤细胞, 肿瘤复发