Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Br J Cancer. 2011 Mar 29;104(7):1178-84. doi: 10.1038/bjc.2011.40. Epub 2011 Feb 22.
The purpose of this study was to detect postoperative persistent circulating tumour cells (CTCs) in stages II and III colon cancer patients undergoing curative resection and so identify a subgroup of patients who are at high risk for early relapse.
Four mRNA molecular markers including human telomerase reverse transcriptase, cytokeratin-19, cytokeratin-20, and carcinoembryonic antigen (CEA) mRNA were used to detect CTCs in 141 stages II and III colon cancer patients undergoing curative resection to determine the significance of CTCs in postoperative early relapse.
Out of 141 patients, postoperative early relapse and non-early relapse/no relapse was found in 48 (34.0%) patients and 93 (66.0%) patients, respectively. Univariately, postoperative early relapse was significantly correlated with lymph node metastasis (P=0.025), vascular invasion (P=0.002), perineural invasion (P=0.001), laparoscopic surgery (P=0.019), high postoperative serum CEA levels (P=0.001), and presence of persistent postoperative CTCs (P<0.001). Using a multivariate proportional hazards regression analysis, the presence of perineural invasion (P=0.034; HR, 1.974; 95% CI: 1.290-3.861), high postoperative serum CEA levels (P=0.020; HR, 2.377; 95% CI: 1.273-4.255), and the presence of persistent postoperative CTCs (P<0.001; HR, 11.035; 95% CI: 4.396-32.190), were demonstrated to be independent predictors for postoperative early relapse. Furthermore, the presence of persistent postoperative CTCs was strongly correlated with a poorer disease-free and overall survival (both P<0.001).
This study suggests that molecular detection of persistent postoperative CTCs is a prognostic predictor of early relapse in UICC stage II/III colon cancer patients, and thus could help to define patients with this tumour entity for an enhanced follow-up and therapeutic program.
本研究旨在检测接受根治性切除术的 II 期和 III 期结肠癌患者术后持续循环肿瘤细胞（CTC），以确定一组具有早期复发高风险的患者。
使用包括人端粒酶逆转录酶、细胞角蛋白-19、细胞角蛋白-20 和癌胚抗原（CEA）mRNA 在内的 4 种 mRNA 分子标志物，对 141 例接受根治性切除术的 II 期和 III 期结肠癌患者进行 CTC 检测，以确定 CTC 在术后早期复发中的意义。
141 例患者中，48 例（34.0%）患者术后早期复发，93 例（66.0%）患者无早期复发/无复发。单因素分析显示，术后早期复发与淋巴结转移（P=0.025）、血管侵犯（P=0.002）、神经周围侵犯（P=0.001）、腹腔镜手术（P=0.019）、术后高血清 CEA 水平（P=0.001）和持续存在的术后 CTCs（P<0.001）显著相关。多因素比例风险回归分析显示，神经周围侵犯（P=0.034；HR，1.974；95%CI：1.290-3.861）、术后高血清 CEA 水平（P=0.020；HR，2.377；95%CI：1.273-4.255）和持续存在的术后 CTCs（P<0.001；HR，11.035；95%CI：4.396-32.190）是术后早期复发的独立预测因素。此外，持续存在的术后 CTCs 与无病生存和总生存较差密切相关（均 P<0.001）。
本研究表明，UICC 分期 II/III 期结肠癌患者术后持续 CTC 的分子检测是早期复发的预后预测指标，因此有助于为该肿瘤实体患者确定强化随访和治疗方案。
