Objective: To detect circulating tumor cells (CTC) in patients with colorectal carcinoma and to evaluate the relationship among CTC, clinic-pathological characteristics and prognosis of colorectal carcinoma. Methods: Peripheral blood samples were obtained from 109 patients with colorectal carcinoma in Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from April 2014 to October 2016. There were 60 male and 49 female patients, aging from 33 to 86 years with a mean age of (65±10) years.CTC were detected using density-gradient centrifugation and immunofluorescence staining. χ(2) test, Fisher exact test and rank-sum test were used to analyze the relation between positive rate of CTC and clinical characteristic, respectively. The correlation analysis of CTC and common tumor markers was detected by χ(2) test and Spearman test. The overall survival of patients was analyzed by Kaplan-Meier curve and Cox proportional hazard model. Results: CTC were found in 71 of the 109 patients with colorectal carcinoma. The presence of CTC was significantly correlated with N stage (Z=4.422, P=0.035) and M stage (χ(2)=4.424, P=0.049). However, CTC was not significantly correlated with age, sex, tumor location, tumor size, differentiation, T stage, Ki-67 and TNM stage (P>0.05). Meanwhile, there was significant correlation between CTC and carcino-embryonic antigen (CEA) (χ(2)=4.897, P=0.027; r=0.212, P=0.027) indicated by χ(2) test and Spearman correlations analysis. The positive rate of CTC was higher than that of CEA (χ(2)=15.45, P=0.000). Survival analysis suggested that positive CTC was poor for overall survival in colorectal cancer with adjusted HR as 3.023(95%CI: 1.330 to 6.872, P=0.008). Conclusions: CTC is helpful to early diagnosis tumor recurrence and metastasis. Hence, combined multiple tumor markers, including the CTC as common indicators of tumor diagnosis, relapse and metastasis could effectively improve the accuracy of diagnosis.
目的： 探讨检测结直肠癌患者外周血循环肿瘤细胞(circulating tumor cells，CTC)的临床意义。 方法： 连续收集2014年4月至2016年10月首都医科大学附属北京友谊医院普外科收治的109例符合入组条件的结直肠癌患者资料，检测外周血CTC并分析CTC与患者临床病理特征及预后的关系。男性60例，女性49例，年龄33～86岁，平均年龄(65±10)岁。采用χ(2)检验、Fisher精确概率检验或秩和检验分析CTC阳性率与临床病理特征的关系，采用χ(2)检验和Spearman相关性检验进行CTC与其他肿瘤标志物的相关性分析，采用Kaplan-Meier曲线及Cox比例风险模型比较患者的总体生存情况。 结果： 109例结直肠癌患者中，71例外周血CTC阳性，其中CTC阳性率与N分期(Z＝4.422，P＝0.035)、M分期(χ(2)＝4.424，P＝0.049)具有相关性，而与结直肠癌患者年龄、性别、肿瘤位置、肿瘤大小、分化程度、T分期、Ki-67指数、TNM分期无相关性(P值均>0.05)；另外，χ(2)检验和Spearman相关性分析结果均显示CTC和癌胚抗原之间存在相关性(χ(2)＝4.897，P＝0.027；r＝0.212，P＝0.027)，且CTC的阳性率高于癌胚抗原(χ(2)＝15.45，P＝0.000)。生存分析结果显示，CTC阳性患者总生存率低于CTC阴性患者，其校正HR＝3.023(95% CI为1.330～6.872，P＝0.008)。 结论： CTC可能反映结直肠肿瘤细胞的转移能力，临床上联合检测CTC及血清肿瘤标志物可以提高结直肠癌诊断的准确性，CTC可以作为判断结直肠癌预后的一个指标。.
Keywords: Colorectal neoplasms; Early diagnosis; Neoplastic cells, circulating.