基于奥沙利铂的一线化疗后 III/IV 期结直肠癌预后中循环肿瘤细胞的预测价值。
Predictive Value of Circulating Tumor Cells in Prognosis of Stage III/IV Colorectal Cancer After Oxaliplatin-based First-line Chemotherapy.
机构信息
Department of General Surgery, Ningbo Medical Treatment Centre Li Huili Hospital, Ningbo, P.R. China.
Li Huili Hospital of Ningbo University, Ningbo, P.R. China.
出版信息
In Vivo. 2022 Mar-Apr;36(2):806-813. doi: 10.21873/invivo.12767.
BACKGROUND/AIM: Insufficient data exist to support the concept of the circulating tumor cell (CTC) level as a prognostic factor for platinum-based first-line chemotherapy. This study investigated the impact of CTCs on the prognosis of patients with advanced colorectal cancer (CRC) after receiving platinum-based chemotherapy. Analyses were carried out of clinicopathological features and molecular phenotypes to clarify independent risk factors for a high CTC count.
PATIENTS AND METHODS
Patients diagnosed with stage III/IV CRC (n=76) were included in the study. The blood samples of patients were evaluated for CTCs using the CellRich™ platform system. Immunohistochemistry (Ias used to analyze epithelial-mesenchymal transition-associated biomarkers E-cadherin and vimentin. Univariate and logistic regression analyses were then conducted to analyze the risk factors for CTC expression. Additionally, the influence of oxaliplatin on disease-free survival after first-line chemotherapy or during chemotherapy was analyzed through a 2-year follow-up.
RESULTS
Patients in the CTC group experienced shorter DFS after receiving oxaliplatin first-line chemotherapy than patients in the CTC group (p<0.01). In addition, univariate analysis revealed that the tumor M-stage, tumor location, RAS mutation, high expression of vimentin, and deletion of E-cadherin expression were correlated with a high CTC count. Multivariate analysis suggested that the presence of RAS gene mutations and high vimentin expression were independent risk factors for high CTC loads (p<0.01).
CONCLUSION
CTC positivity can indicate the efficacy of first-line chemotherapy with oxaliplatin in stage III/IV colorectal cancer. This may be linked to tumor epithelial-mesenchymal transition in patients with CTCs. Moreover, RAS gene mutation and high expression of vimentin were identified as independent risk factors for a high CTC count.
背景/目的：目前尚无足够的数据支持循环肿瘤细胞（CTC）水平作为铂类一线化疗患者预后因素的概念。本研究旨在探讨 CTC 对接受铂类化疗的晚期结直肠癌（CRC）患者预后的影响。通过分析临床病理特征和分子表型，阐明了 CTC 计数高的独立危险因素。
患者和方法
纳入了 76 例诊断为 III/IV 期 CRC 的患者。使用 CellRich™平台系统评估患者的血液样本中的 CTC。采用免疫组织化学（IHC）分析上皮-间充质转化相关标志物 E-钙黏蛋白和波形蛋白。然后进行单因素和逻辑回归分析，以分析 CTC 表达的危险因素。此外，通过 2 年随访分析一线化疗或化疗期间奥沙利铂对无病生存期（DFS）的影响。
结果
接受奥沙利铂一线化疗的 CTC 组患者的 DFS 短于 CTC 组（p<0.01）。此外，单因素分析显示，肿瘤 M 分期、肿瘤位置、RAS 突变、高表达波形蛋白和 E-钙黏蛋白表达缺失与 CTC 计数高相关。多因素分析表明，RAS 基因突变和高表达波形蛋白是 CTC 负荷高的独立危险因素（p<0.01）。
结论
CTC 阳性可提示 III/IV 期结直肠癌患者接受奥沙利铂一线化疗的疗效。这可能与 CTC 患者的肿瘤上皮-间充质转化有关。此外，RAS 基因突变和高表达波形蛋白被确定为 CTC 计数高的独立危险因素。
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