Yamashita J I, Kurusu Y, Fujino N, Saisyoji T, Ogawa M
Department of Surgery II, Kumamoto University School of Medicine, Kumamoto, Japan.
J Thorac Cardiovasc Surg. 2000 May;119(5):899-905. doi: 10.1016/S0022-5223(00)70084-5.
We prospectively tested whether circulating tumor cells can be found in the preoperative, intraoperative, and postoperative peripheral blood of patients with resectable non-small cell lung cancer who undergo video-assisted lobectomy.
We assayed for carcinoembryonic antigen messenger RNA (mRNA) by reverse transcriptase-polymerase chain reaction in the peripheral blood taken before, during, just after the completion of the lobectomy and then 2 to 3 weeks, and again 5 to 6 weeks, after the operation in 29 patients with pathologic stage I non-small cell lung cancer who underwent video-assisted lobectomy. We also analyzed the prognostic value of carcinoembryonic antigen mRNA expression pattern in an additional 57 patients with stage I non-small cell lung cancer, whose blood samples were previously assayed for carcinoembryonic antigen mRNA.
Of the 29 patients, the preoperative blood samples from 18 patients were negative for carcinoembryonic antigen mRNA. Of these 18 patients, 16 (89%) had positive test results during operation, although the remaining 2 patients (11%) consistently showed negative test results. The occurrence of this change from negative to positive tests results for carcinoembryonic antigen mRNA during video-assisted lobectomy was significantly higher than in patients who underwent open lobectomy in a previous study (18 of 35 patients; 51%; P <.001). In the 57 patients with stage I cancer whose blood samples were previously assayed for carcinoembryonic antigen mRNA, patients with persistently positive test results for carcinoembryonic antigen mRNA before and during operation had a significantly shorter survival when compared with those patients whose test results were persistently positive.
Video-assisted lobectomy, as compared with open lobectomy, for non-small cell lung cancer may increase the risk of seeding tumor cells into the circulation during operation.
我们前瞻性地检测了接受电视辅助肺叶切除术的可切除性非小细胞肺癌患者术前、术中和术后外周血中是否能检测到循环肿瘤细胞。
我们采用逆转录-聚合酶链反应检测了29例接受电视辅助肺叶切除术的病理I期非小细胞肺癌患者术前、术中、肺叶切除刚结束后、术后2至3周以及术后5至6周外周血中的癌胚抗原信使核糖核酸（mRNA）。我们还分析了另外57例I期非小细胞肺癌患者癌胚抗原mRNA表达模式的预后价值，这些患者的血样之前已检测过癌胚抗原mRNA。
29例患者中，18例患者的术前血样癌胚抗原mRNA检测为阴性。在这18例患者中，16例（89%）术中检测结果为阳性，尽管其余2例（11%）始终为阴性。电视辅助肺叶切除术中癌胚抗原mRNA检测结果从阴性变为阳性的发生率显著高于先前一项研究中接受开放性肺叶切除术的患者（35例患者中的18例；51%；P<.001）。在57例I期癌症患者中，其血样之前已检测过癌胚抗原mRNA，术前和术中癌胚抗原mRNA检测结果持续为阳性的患者与检测结果持续为阳性的患者相比，生存期显著缩短。
与开放性肺叶切除术相比，电视辅助肺叶切除术治疗非小细胞肺癌可能会增加手术期间肿瘤细胞播散入循环的风险。
