Choy A, McCulloch P
University Department of Surgery, Royal Liverpool University Hospital, UK.
Br J Cancer. 1996 Jan;73(1):79-82. doi: 10.1038/bjc.1996.14.
Surgeons have long been concerned that cancer may be disseminated by shedding of tumour cells into the bloodstream during surgery. Early claims that cancer operations induced an increase in the number of tumour cells shed into the circulation were subsequently discredited, and the issue has remained unresolved. We used immunocytochemistry for cytokeratins to detect tumour cells in effluent blood from breast carcinomas in 18 patients undergoing surgery. Tumour cells were detectable in 6/18 patients during surgery, in only one patient before operation and in none post-operatively (P = 0.025). Circulating cells were associated with vascular invasion within the primary tumour (P = 0.032). No cytokeratin-positive cells were found in blood from ten normal volunteers or four patients undergoing surgery for other breast conditions. These results confirm that cancer surgery in humans results in an increase in the shedding of tumour cells into the circulation. The implications for prognosis and practice should be determined by larger prospective studies.
长期以来，外科医生一直担心在手术过程中，肿瘤细胞可能会通过脱落进入血液循环而发生播散。早期有观点认为癌症手术会导致进入循环系统的肿瘤细胞数量增加，但这一观点后来被证明是不可信的，该问题至今仍未得到解决。我们采用细胞角蛋白免疫细胞化学方法，对18例接受手术的乳腺癌患者流出的血液中的肿瘤细胞进行检测。手术过程中，18例患者中有6例可检测到肿瘤细胞，术前仅1例可检测到，术后均未检测到（P = 0.025）。循环细胞与原发肿瘤内的血管侵犯相关（P = 0.032）。在10名正常志愿者或4名因其他乳腺疾病接受手术的患者的血液中未发现细胞角蛋白阳性细胞。这些结果证实，人类癌症手术会导致进入循环系统的肿瘤细胞脱落增加。其对预后和临床实践的影响应由更大规模的前瞻性研究来确定。
