Rolle Axel, Günzel Rainer, Pachmann Ulrich, Willen Babette, Höffken Klaus, Pachmann Katharina
TZB Transfusionsmedizinisches Zentrum Bayreuth, der Friedrich-Schiller-Universität Jena, Germany.
World J Surg Oncol. 2005 Mar 31;3(1):18. doi: 10.1186/1477-7819-3-18.
Lung cancer still remains one of the most commonly occurring solid tumors and even in stage Ia, surgery fails in 30% of patients who develop distant metastases. It is hypothesized that these must have developed from occult circulating tumor cells present at the time of surgery, or before. The aim of the present study was to detect such cells in the peripheral blood and to monitor these cells following surgery. METHODS: 30 patients treated for lung cancer with surgery were monitored for circulating epithelial cells (CEC) by taking peripheral blood samples before, 2 weeks and 5 months after surgery and/or radiotherapy (RT) chemotherapy (CT) or combined RT/CT using magnetic bead enrichment and laser scanning cytometry (MAINTRAC(R)) for quantification of these cells. RESULTS: In 86% of the patients CEC were detected before surgery and in 100% at 2 weeks and 5 months after surgery. In the control group, which consisted of 100 normal donors without cancer, 97 % were negative for CEC. A significantly higher number of CEC was found preoperatively in patients with squamous cell carcinoma than in those with adenocarcinoma. In correlation to the extent of parenchymal manipulation 2 weeks after surgery, an increase in numbers of CEC was observed with limited resections (18/21) whereas pneumonectomy led to a decrease (5/8) of CEC, 2 weeks after surgery. The third analysis done 5 months after surgery identified 3 groups of patients. In the group of 5 patients who received neo- or adjuvant chemo/radiotherapy there was evidence that monitoring of CEC can evaluate the effects of therapy. Another group of 7 patients who underwent surgery only showed a decrease of CEC and no signs of relapse. A third group of 11 patients who had surgery only, showed an increase of CEC (4 with an initial decrease after surgery and 7 with continuous increase). In the group with a continuous increase during the following 24 months, 2 early relapses in patients with stage Ia adenocarcinoma were observed. The increase of CEC preceded clinical detection by six months. CONCLUSION: We consider, therefore, that patients with adenocarcinoma and a continuous increase of CEC after complete resection for lung cancer are at an increased risk of early relapse.
肺癌仍然是最常见的实体瘤之一，即使在Ia期，30%接受手术的患者会发生远处转移，手术失败。据推测，这些转移肯定是由手术时或手术前存在的隐匿性循环肿瘤细胞发展而来。本研究的目的是检测外周血中的此类细胞，并在手术后对这些细胞进行监测。方法：对30例接受肺癌手术治疗的患者，在手术前、手术后2周和5个月以及/或放疗（RT）、化疗（CT）或联合RT/CT后，采集外周血样本，采用磁珠富集和激光扫描细胞术（MAINTRAC®）监测循环上皮细胞（CEC），以对这些细胞进行定量分析。结果：86%的患者在手术前检测到CEC，100%在手术后2周和5个月检测到。在由100名无癌症的正常供者组成的对照组中，97%的CEC检测为阴性。鳞状细胞癌患者术前检测到的CEC数量明显高于腺癌患者。与手术后2周实质操作的程度相关，有限切除（18/21）的患者CEC数量增加，而肺叶切除术后CEC数量减少（5/8）。手术后5个月进行的第三次分析确定了3组患者。在接受新辅助或辅助化疗/放疗的5例患者组中，有证据表明监测CEC可以评估治疗效果。另一组仅接受手术的7例患者CEC数量减少，且无复发迹象。第三组仅接受手术的11例患者CEC数量增加（4例术后最初减少，7例持续增加）。在接下来24个月持续增加的组中，观察到2例Ia期腺癌患者早期复发。CEC数量增加比临床检测提前6个月。结论：因此，我们认为，肺癌完全切除后CEC持续增加的腺癌患者早期复发风险增加。
