[非小细胞肺癌放化疗患者外周血微转移的检测及预后意义]

[Detection and prognostic significance of micrometastasis in peripheral blood of patients with non-small cell lung cancer treated by chemo-radiation therapy].

作者信息

Chen Ting-feng, Jiang Guo-liang, Zhang Yi-qin, Wang Li-juan, Fu Xiao-long, Qian Hao, Wu Kai-liang, Zhao Sen

机构信息

Department of Radiation Oncology, Jiangsu Province Cancer Hospital/Cancer Institute, Nanjing 210009, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2007 May;29(5):365-8.

PMID:17892133

Abstract

OBJECTIVE

To investigate the prognostic significance of micrometastasis (MM) in peripheral blood of patients with non-small cell lung cancer (NSCLC) treated by chemo-radiation therapy.

METHODS

Peripheral blood was taken from 67 NSCLC patients before and after definitive chemo-radiation therapy. CK19 mRNA of the peripheral blood was measured by nested RT-PCR and both their relationship with clinicopathological features and prognostic significance were further investigated.

RESULTS

The micrometastasis-positive rates were 65.7% (44/67) and 32.8% (22/67), respectively, before and after the treatment. The micrometastasis-positive rate before treatment was closely in correlation with N-stage (P = 0.014). In contrast, it turned out to be more closely related with histological types (P = 0.019), weight loss (P = 0.01), KPS status (P = 0.027) as well as N-stage (P = 0.032) after chemo-radiation therapy. 4-yr distant metastasis rates (DMR) for micrometastasis-positive and -negative patients were 78.3% and 70.4%, respectively, before the treatment (P = 0.544) while they were 100% and 62.9%, respectively, after the chemoradiation (P < 0.001). The median survival time (MST) and 4-yr overall survival rate (OSR) for pretreatment micrometastasis-positive and -negative patients were 13.8 months and 17.6 months, and 18.2% and 17.4%, respectively (P = 0.619), while for post-treatment micrometastasis-positive and -negative patients they were 7.8 months and 27.6 months and 0 and 26.4%, respectively (P < 0.001). Multivariate analysis showed that the post-treatment positive micrometastasis was an independent unfavorable prognostic factor (P = 0.000).

CONCLUSION

Detection of micrometastasis in peripheral blood may possess a prognostic significance after definitive chemo-radiation therapy. Micrometastasis-negative patients have better prognosis compared to those with positive micrometastasis.

摘要

目的

探讨非小细胞肺癌（NSCLC）患者经放化疗后外周血微转移（MM）的预后意义。

方法

采集67例NSCLC患者放化疗前后的外周血。采用巢式逆转录聚合酶链反应（nested RT-PCR）检测外周血CK19 mRNA，并进一步研究其与临床病理特征的关系及预后意义。

结果

治疗前、后微转移阳性率分别为65.7%（44/67）和32.8%（22/67）。治疗前微转移阳性率与N分期密切相关（P = 0.014）。相比之下，放化疗后其与组织学类型（P = 0.019）、体重减轻（P = 0.01）、KPS评分（P = 0.027）以及N分期（P = 0.032）的相关性更强。微转移阳性和阴性患者治疗前4年远处转移率（DMR）分别为78.3%和70.4%（P = 0.544），而放化疗后分别为100%和62.9%（P < 0.001）。治疗前微转移阳性和阴性患者的中位生存时间（MST）和4年总生存率（OSR）分别为13.8个月和17.6个月，以及18.2%和17.4%（P = 0.619），而治疗后微转移阳性和阴性患者分别为7.8个月和27.6个月，以及0和26.4%（P < 0.001）。多因素分析显示，治疗后微转移阳性是独立的不良预后因素（P = 0.000）。