本文關(guān)鍵詞：循環(huán)腫瘤細胞在中晚期非小細胞肺癌化療療效監(jiān)測及預(yù)后判斷中的初步探討　出處：《南華大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 非小細胞肺癌 循環(huán)腫瘤細胞 臨床分期 療效 預(yù)后

【摘要】：目的:本研究通過動態(tài)監(jiān)測中晚期非小細胞肺癌患者化療前、2周期化療后及影像學(xué)評估進展時CTCs的水平。側(cè)重探討CTCs與近期療效及患者預(yù)后的相關(guān)性,進一步探討其臨床應(yīng)用價值;并分析多因素對患者預(yù)后的影響,明確CTCs能否作為判別患者預(yù)后的獨立因素。方法:采用Cellsearch系統(tǒng)檢測了118例晚中期非小細胞肺癌患者化療前CTCs水平,有效病例數(shù)107例;其中有78例患者在2周期化療后進行了影像學(xué)評估,同時抽血行CTCs檢測;78例患者中,有42例隨訪過程中出現(xiàn)PD,并在PD時再次抽血行CTCs檢測。關(guān)于非小細胞肺癌CTCs陽性標準,目前尚無最佳臨界值(cut-off)界定,本研究把cut-off值確定為1個,即只要在7.5ml外周血中發(fā)現(xiàn)CTCs則為陽性。結(jié)果:1.CTCs患者PFS的相關(guān)性:107例患者均在化療前行CTCs檢測,CTCs陽性率為39.3%;陽性患者中位PFS為4.3月,陰性患者為7.3月,數(shù)據(jù)有統(tǒng)計學(xué)差異(P=0.002);其中有78例患者在2周期化療后行CTCs檢測,陽性組中位PFS為2.5月,陰性者為5.8月,兩組差別有統(tǒng)計學(xué)意義(P=0.002);化療前后CTCs變化水平與患者中位PFS無統(tǒng)計學(xué)意義。2.CTCs與患者遠期生存的相關(guān)性:化療前CTCs陽性患者1年生存率為35.7%,陰性患者為60.0%,差異有統(tǒng)計學(xué)意義(P=0.014);2周期化療后ctcs陽性患者1年生存率為30.0%,陰性患者為56.8%,差異有統(tǒng)計學(xué)差異(p=0.038);化療前后ctcs變化及疾病進展時ctcs水平與1年生存率差異無統(tǒng)計學(xué)意義。3.化療前后ctcs變化與影像學(xué)評估的相關(guān)性:78例患者在化療前及2周期化療后行影像學(xué)評估,并抽血行ctcs檢測,化療前ctcs陽性率41.0%,化療后陽性率25.6%,化療前后ctcs變化具有統(tǒng)計學(xué)差異。按照recist評價標準,有25例患者獲得pr,37例患者為sd,16例患者評價為pd,無cr患者�；熐昂骳tcs上升17例,下降21例,無變化40例。數(shù)據(jù)統(tǒng)計表明,在近期療效評價中,ctcs變化水平與影像學(xué)評價具有很高的一致性。以ctcs陽性率分層顯示,影像學(xué)評價顯示pd的患者,ctcs陽性率高達68.8%,而影像學(xué)評價sd的患者,ctcs陽性率18.4%,影像學(xué)評價為pr的患者,其ctcs陽性率僅為8.2%,且數(shù)據(jù)具有統(tǒng)計學(xué)差異(p0.05)。4.疾病進展時ctcs水平與局部復(fù)發(fā)、遠處復(fù)發(fā)的關(guān)系:在42例pd患者中,ctcs陽性患者28例,其中遠處轉(zhuǎn)移復(fù)發(fā)比率為71.4%,ctcs陰性患者14例,遠處轉(zhuǎn)移復(fù)發(fā)比率為35.7%,數(shù)據(jù)有統(tǒng)計學(xué)差異(p=0.026)。5.患者tnm分期與pfs相關(guān),患者年齡及吸煙史均與1年生存率相關(guān)。結(jié)論:1.化療前、2周期化療后循環(huán)腫瘤細胞水平是pfs的預(yù)測因素;2.化療前循環(huán)腫瘤細胞水平是患者1年生存期的預(yù)測因素;3.化療前后CTCs變化與影像學(xué)化療療效評估具有一致性。
[Abstract]:Objective: to dynamically monitor the level of CTCs in patients with advanced non-small cell lung cancer (non-small cell lung cancer) before and after chemotherapy and imaging evaluation of advanced non-small cell lung cancer (non-small cell lung cancer). We focused on the relationship between CTCs and short-term prognosis and prognosis, and further explored its clinical application value. We also analyzed the influence of multiple factors on the prognosis of patients, and determined whether CTCs could be used as an independent prognostic factor. Methods: the Cellsearch was detected in 118 cases of late stage non-small cell lung cancer patients before chemotherapy CTCs level, effective 107 cases; there were 78 patients in the 2 cycle of chemotherapy after the imaging assessment and blood CTCs detection; 78 cases of patients, 42 cases were followed up after PD process. And in the PD again when the blood for CTCs detection. There is no optimal threshold value (cut-off) for the CTCs positive standard of non-small cell lung cancer. In this study, the cut-off value is identified as 1, that is, as long as CTCs is found in peripheral blood of 7.5ml, it is positive. Results: the correlation between 1.CTCs PFS patients: 107 cases of patients before chemotherapy in CTCs detection, the positive rate of CTCs was 39.3%; in patients with positive PFS negative patients was 4.3 months, 7.3 months, the data have significant difference (P=0.002); there were 78 patients in the 2 cycle of chemotherapy were tested by CTCs, in a positive group PFS for 2.5 months, the negative of 5.8 months, there was a significant difference between the two groups (P=0.002); CTCs level and patients with a PFS had no statistical significance before and after chemotherapy. The correlation between 2.CTCs and long-term survival of the patients before chemotherapy in CTCs positive patients 1 year survival rate was 35.7%, negative patients was 60%, the difference was statistically significant (P=0.014); after 2 cycles of chemotherapy in CTCs positive patients 1 year survival rate was 30%, negative patients was 56.8%, the difference had statistical difference was not statistically significant (p=0.038); before and after chemotherapy and disease progression of CTCS changes in CTCS Level and 1 year survival rate difference. 3., the correlation between CTCs and imaging evaluation before and after chemotherapy: 78 patients underwent imaging evaluation before chemotherapy and 2 cycles of chemotherapy, and blood samples were taken for CTCs detection. The positive rate of CTCS before chemotherapy was 41%, and the positive rate after chemotherapy was 25.6%. There was statistical difference in CTCs before and after chemotherapy. According to the RECIST evaluation criteria, 25 patients received PR, 37 patients were SD, 16 patients were evaluated as PD, and no CR patients. Before and after chemotherapy, CTCs increased in 17 cases, decreased in 21 cases, and no change in 40 cases. Data statistics show that in the recent evaluation of curative effect, the level of CTCS changes is very consistent with the evaluation of imaging. The positive rate of CTCS was stratified. Imaging evaluation showed that the positive rate of CTCS in PD patients was as high as 68.8%, while the CTCs positive rate was 18.4% in patients with SD imaging. The positive rate of CTCS in radiographic evaluation of PR was only 8.2%, and the data had statistical difference (P0.05). 4., the relationship between CTCS Level and local recurrence and distant recurrence in disease progression: in 42 PD patients, 28 cases of CTCS positive patients, including distant metastasis recurrence rate 71.4%, CTCs negative patients 14 cases, distant metastasis recurrence rate 35.7%, and the data were statistically different (p=0.026). 5. patients with TNM staging were associated with PFS, and the age and smoking history of the patients were related to the 1 year survival rate. Conclusion: 1.. The level of circulating tumor cells before and after 2 cycles of chemotherapy is a predictor of PFS. 2., the level of circulating tumor cells before chemotherapy is the predictor of 1 year survival of patients. 3., the CTCs change before and after chemotherapy is consistent with imaging chemotherapy efficacy evaluation.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R734.2

【參考文獻】

相關(guān)期刊論文 前8條

1 吳國明;錢桂生;;應(yīng)進一步加強對非小細胞肺癌靶向治療的研究[J];中華醫(yī)學(xué)雜志;2014年30期

2 陳燕;李虎;秦琴;谷明莉;張薇薇;徐玉蓮;方超萍;鄧安梅;石磊;錢t$;;非小細胞肺癌患者外周血循環(huán)腫瘤細胞的檢測及與病理分期關(guān)系[J];臨床軍醫(yī)雜志;2014年02期

3 李晶;姜北;萬鵬;李娜;王于理;鞏平;;晚期非小細胞肺癌患者循環(huán)腫瘤細胞檢測的臨床意義[J];中國全科醫(yī)學(xué);2013年33期

4 劉斌;劉德森;潘泓;羅元;吳平尚;陳杰敏;;ERCC1、RRM1基因表達與非小細胞肺癌患者預(yù)后的相關(guān)性[J];中國癌癥防治雜志;2012年03期

5 趙玲娣;張湘茹;李峻嶺;王子平;王燕;郝學(xué)志;胡興勝;周生余;孫燕;石遠凱;;不同三代新藥與鉑聯(lián)合一線雙藥方案對晚期非小細胞肺癌的療效分析[J];中華醫(yī)學(xué)雜志;2012年22期

6 蔣蔚峰;張賀龍;;外周血循環(huán)腫瘤細胞檢測的研究進展[J];臨床腫瘤學(xué)雜志;2010年10期

7 周小昀;李龍蕓;郝淮杰;王樹蘭;郭子健;王孟昭;張力;鐘巍;冉然;張曉彤;徐麗艷;林平;;外周血循環(huán)腫瘤細胞在晚期肺癌患者的預(yù)測及預(yù)后價值研究[J];癌癥進展;2010年05期

8 支修益;;我國肺癌流行病學(xué)現(xiàn)狀分析[J];中國處方藥;2009年02期

，

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