南方医科大学附属中山博爱医院病理科,广东,中山,528400
网络首发:2018-11-20,
纸质出版:2018
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陈志强, 米贤军, 苏年华, 等. 外周血循环肿瘤细胞检测在筛查卵巢上皮性癌中的应用[J]. 中山大学学报(医学科学版), 2018,39(6).
Preliminary Study of Peripheral Blood Circulating Tumor Cell Detection in Screening of Ovarian Epithelial Cancer[J]. Journal of Sun Yat-sen University (Medical Sciences), 2018, 39(6).
【目的】检测健康女性、卵巢良性上皮性肿瘤患者及卵巢恶性上皮性癌患者(含各分期)外周血循环 肿瘤细胞(CTC)阳性率及数量差异,初步评估CTC检测在卵巢恶性上皮性癌筛查中的临床意义。【方法】选取中 山市博爱医院、中山大学附属中山医院2016年1月至2017年12月期间,151例健康女性体检者(正常组)、138例 卵巢上皮性良性肿瘤患者(良性组)、92例卵巢上皮性癌,含所有类型及临床分期的卵巢上皮性癌患者(恶性组) 为研究对象,卵巢肿瘤患者以病理组织学结果为金标准,采集患者术前和正常组静脉血液样本,采用免疫磁珠微 粒阴性富集法和免疫荧光原位杂交法检测研究对象的CTC,使用SPSS20.0比较3组外周血CTC阳性率及数量差 异;统计分析CTC检测诊断卵巢上皮性癌的灵敏度、特异度、符合率、阳性预测值和阴性预测值,综合评估CTC检 测诊断卵巢上皮性癌的价值。【结果】①正常组、良性组与恶性组CTC阳性率分别为0、 0和90.22%,总体差异具 有统计学意义(P<0.001);恶性组与正常组、恶性组与良性组相比差异均具有统计学意义(均P<0.001)。②恶 性组Ⅰ~Ⅳ期CTC阳性率分别为81.25%、89.47%、90.32%和96.15%,差异无统计学意义(P=0.47)。③正常组、良 性组与恶性组CTC均数分别为0、(0.02±0.15)和(8.27±10.88)个,总体差异有统计学意义(P<0.001),良性组与 正常组间无差异(P=0.97),恶性组与良性组、恶性组与正常组差异均有统计学意义(均P<0.001)。④恶性组Ⅰ~ Ⅳ期CTC均数分别为(2.13±1.31)个、(2.68±1.53)个、(5.90±2.95)个、(19.35±15.19)个,总体差异有统计学意 义(P<0.001),除Ⅲ期与Ⅱ期(P=0.19)、Ⅲ期与Ⅰ期(P=0.14)、Ⅱ期与Ⅰ期(P=0.84)差异无统计学意义外,其 余各期之间均有统计学意义(均P<0.001)。⑤CTC诊断卵巢上皮性癌的灵敏度、特异度、符合率分别为90.22%、 100%、97.64%。【结论】卵巢上皮性癌患者CTC阳性率与均数均为最高;CTC均数与卵巢上皮性癌临床分期具有 相关性,提示CTC在卵巢上皮性癌的早期诊断及临床分期预测中具有较高的临床价值。
【Objective】To detect the positive rate and number of circulating tumorcells(CTC)inperipheral blood of healthy women,benign epithelial ovarian tumors and patients with ovarian malignante pithelial cancer(includingallstages),and to preliminarily evaluate the clinical significance of CTC detection in ovarian malignan tepithelial cancer screening.【Methods】This project was achieved by collecting 151 female controls(normal group),138 cases of benign ovarian epithelial tumor(benign group)and 92 cases of ovarian epithelial cancer(epithelial ovarian cancer including all types and clinical stages)patients(malignant group),sent from Zhongshan Boai Hospital and Zhongshan Hospital from January 2016 to December 2017. Patients with ovarian cancer were detected by gold pathological standard. Venous blood samples were collected before surgery in each group. Negative enrichment of immunomagnetic beads and immunofluorescence in situ hybridization were using. Then we compared positive rate of CTC inperipheral blood and the number of differences;statistical analysis CTC detection and diagnosis ovarian epithelial cancer,sensitivity,specificity,accuracy,positive predictive value and negative predictive value,the value of comprehensive evaluation of CTC detection in the diagnosis of ovarian epithelial cancer. 【Results】①The positive rates of CTC in the normal group,the benign group and the malignant group were 0,0 and 90.22%,respectively. The overall difference was statistically significant(P<0.001);The difference between the malignant group and the normal group,the malignant group and the benign group was statistically significant(P<0.001) . ②The positive rates of CTC instageⅠ-Ⅳgroup were 81.25%,89.47%,90.32% and 96.15%. The difference was not statistically significant(P=0.47) . ③The average number of CTC in the normal group,the benign group and the malignant group were 0,(0.02±0.15),(8.27±10.88). The total difference was statistically significant (P<0.001). There was no difference between the benign group and the normal group(P=0.97),but were significant differences between the malignant group and the benign group,the malignant group and the normal group(all P <0.001) . ④The mean CTC in stageⅠ-Ⅳ of malignant group were(2.13±1.31), (2.68±1.53), (5.90±2.95),and(19.35± 15.19),respectively. The difference was statistically significant(P<0.001).There was no significant difference between stage Ⅲ and stage Ⅱ(P=0.19),stage Ⅲ and stage I(P=0.14),stage II and stage I(P=0.84),and there stperiods were statistically significant(P <0.001) . ⑤The sensitivity,specificity,and accuracy of CTC diagnosis in ovarian epithelial cancer,were 90.22%,100%,and 97.64%. 【Conclusion】The positive rate and the average number of CTC in ovarian epithelial cancer patients are the highest,and the mean number of CTC is correlated with the clinical stage of ovarian epithelial cancer. It indicates that CTC has high clinical value in the early diagnosis and clinical stage prediction of ovarian epithelial cancer.
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