Matsutani Noriyuki, Sawabata Noriyoshi, Yamaguchi Masafumi, Woo Tetsukan, Kudo Yujin, Kawase Akikazu, Shiono Satoshi, Iinuma Hisae, Morita Shigeki, Kawamura Masafumi
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Department of Thoracic Surgery, Hoshigaoka Medical Center, Osaka, Japan.
J Thorac Dis. 2017 Aug;9(8):2419-2426. doi: 10.21037/jtd.2017.07.33.
Cancer relapse is caused by residual isolated tumor cells (ITCs) remaining in the body after surgery. It is speculated that surgical manipulation may cause circulating tumor cells (CTCs) which are the origin of ITCs in the body. The occurrence of CTCs in surgical patients with non-small cell lung cancer (NSCLC) has been shown in retrospective observation, but not prospectively, thus we conducted a multicenter prospective study regarding the occurrence of CTCs by surgical manipulation.
Patients with T1b-2N0M0 lung cancer were studied. Blood samples were collected from the peripheral artery in the operating room at both pre- and post-lobectomy to extract CTCs by a size selection method. The CTCs detection rate, pathological findings, and background of each patient were studied.
The histological diagnosis of 29 patients were adenocarcinoma in 24 patients, squamous cell carcinoma in 3 patients, and other types in 2 patients. The number of pre-CTCs positive patients was 13 and the number of post CTCs positive patients was 17. Among the 16 patients who were pre-CTCs negative, 4 patients showed post CTCs positive, while all pre-CTCs positive patients remained post-CTCs positive.
The likelihood of CTC dislodgement by surgical manipulation is indicated based on the result that CTCs were detected after lung cancer surgery, where there were no cases of pre-CTCs positive and post CTCs negative.
癌症复发是由手术后残留在体内的孤立肿瘤细胞（ITC）引起的。据推测，手术操作可能会导致循环肿瘤细胞（CTC）的产生，而CTC是体内ITC的来源。非小细胞肺癌（NSCLC）手术患者中CTC的出现已在回顾性观察中得到证实，但尚未进行前瞻性研究，因此我们开展了一项关于手术操作导致CTC出现的多中心前瞻性研究。
对T1b-2N0M0期肺癌患者进行研究。在肺叶切除术前和术后，于手术室从外周动脉采集血样，采用大小筛选法提取CTC。研究了每位患者的CTC检测率、病理结果和背景情况。
29例患者的组织学诊断为：腺癌24例，鳞状细胞癌3例，其他类型2例。术前CTC阳性患者13例，术后CTC阳性患者17例。在术前CTC阴性的16例患者中，4例术后CTC呈阳性，而所有术前CTC阳性患者术后仍为阳性。
基于肺癌手术后检测到CTC这一结果表明手术操作导致CTC脱落的可能性，其中不存在术前CTC阳性而术后CTC阴性的病例。
