Kawase Akikazu, Sekihara Keigo, Matsutani Noriyuki, Yamaguchi Masafumi, Kudo Yujin, Endo Makoto, Woo Tetsukan, Saito Yuichi, Sawabata Noriyoshi
First Department of Surgery, Hamamatsu University of Medicine, Hamamatsu 431-3192, Japan.
Department of Thoracic Surgery, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan.
J Clin Med. 2025 Mar 18;14(6):2070. doi: 10.3390/jcm14062070.
In our previous multicenter prospective controlled study (UMIN000018602), we investigated the impact of surgical manipulation on circulating tumor cells (CTCs) in patients with non-small cell lung cancer (NSCLC). CTCs were detected after surgery in four patients (4/29, 13.8%), although CTCs were not present before surgery. These four patients had tumor cells leaked into their bloodstream by surgeons' manipulation. We aimed to clarify long-term outcomes according to the presence of CTCs. Patients with cT1b-2N0M0 NSCLC scheduled for lobectomy were enrolled, based on the selection criteria of a consolidation-to-ground-glass opacity ratio (over 50%). Peripheral blood samples (≥3 mL) were collected before surgery (for pre-CTCs), during surgery, and immediately after pulmonary vein dissection (for post-CTCs). CTCs were isolated from these samples using ScreenCell's size-selective method. From July 2015 to January 2016, 29 patients were enrolled, yielding paired pre- and post-CTC samples for all patients. Thirteen patients were pre-CTC positive, and post-CTCs were detected in 17 patients. Survival analysis revealed a statistically significant difference in recurrence-free survival between patients with and without post-CTCs ( = 0.043), while pre-CTCs status had no significant impact on recurrence ( = 0.226). Patients with post-CTCs had a significantly higher recurrence rate than those without ( = 0.043). Half of patients with post-CTCs but without pre-CTCs had recurrence within 5 years after surgery. Post-CTCs emerged as a significant predictor of recurrence following lobectomy; however, it could be possible for thoracic surgeons to prevent recurrence by improving surgical techniques for NSCLC patients with post-CTCs but without pre-CTCs.
在我们之前的多中心前瞻性对照研究（UMIN000018602）中，我们调查了手术操作对非小细胞肺癌（NSCLC）患者循环肿瘤细胞（CTC）的影响。尽管术前未检测到CTC，但术后在4例患者（4/29，13.8%）中检测到了CTC。这4例患者的肿瘤细胞因外科医生的操作而漏入血液中。我们旨在根据CTC的存在情况阐明长期预后。根据实性成分与磨玻璃影比例（超过50%）的选择标准，纳入计划行肺叶切除术的cT1b-2N0M0 NSCLC患者。在手术前（用于术前CTC检测）、手术期间以及肺静脉解剖后立即采集外周血样本（≥3 mL）（用于术后CTC检测）。使用ScreenCell的大小选择方法从这些样本中分离CTC。2015年7月至2016年1月，共纳入29例患者，所有患者均获得配对的术前和术后CTC样本。13例患者术前CTC呈阳性，17例患者检测到术后CTC。生存分析显示，术后有CTC和无CTC的患者在无复发生存期方面存在统计学显著差异（P = 0.043），而术前CTC状态对复发无显著影响（P = 0.226）。术后有CTC的患者复发率明显高于无CTC的患者（P = 0.043）。术后有CTC但术前无CTC的患者中有一半在术后5年内复发。术后CTC成为肺叶切除术后复发的重要预测指标；然而，胸外科医生有可能通过改进手术技术来预防术后有CTC但术前无CTC的NSCLC患者复发。
