本文選題：結(jié)直腸腫瘤　切入點：腫瘤細胞　出處：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過對結(jié)直腸癌患者循環(huán)腫瘤細胞(CTC)的檢測,評價其在分期、評估療效、監(jiān)測復發(fā)轉(zhuǎn)移及診斷中的價值。方法:(1)采集符合納入標準的初治結(jié)直腸癌患者及健康對照外周血7.5ml,用包被有抗上皮細胞黏附分子(Epithelial cell adhesion molecule,EpCAM)抗體的磁珠對CTC進行富集,對細胞角蛋白陽性(CK+),核染陽性(DAPI+),白細胞共同抗原陰性(CD45-)的CTC進行計數(shù),分析結(jié)直腸癌患者治療前CTC陽性率與臨床病理特征的關(guān)系,評估其在分期中的價值;(2)同時對上述患者中接受手術(shù)的41例患者于術(shù)后7天進行CTC檢測,分析手術(shù)前后CTC陽性率的差異,評價CTC評估療效的價值;(3)另選取一組既往于我院行結(jié)直腸癌手術(shù)且一個月內(nèi)未行任何治療的復查患者82例進行CTC檢測,分析復發(fā)轉(zhuǎn)移患者與非復發(fā)轉(zhuǎn)移患者CTC陽性率的差異,評價其檢測復發(fā)轉(zhuǎn)移的價值;(4)另本研究還對34例結(jié)直腸良性腫瘤患者進行CTC檢,評價其診斷價值。結(jié)果:(1)結(jié)直腸癌患者外周血中CTC的陽性率與患者的N分期及M分期顯著相關(guān)(N0、N1、N2期CTC陽性率分別為38.3%、37.9%、63.9%;M1、M2期CTC陽性率分別為38.0%、71.1%),差異有統(tǒng)計學意義(N分期:χ~2=6.819,P=0.033;M分期:χ~2=12.074,P=0.001);而與性別、年齡、原發(fā)灶部位、T分期、血小板、脈管癌栓、自然殺傷細胞、調(diào)節(jié)性T細胞未見顯著差異(P0.05)。(2)McNemar統(tǒng)計結(jié)果顯示:手術(shù)前后患者CTC陽性率未見顯著差異(P=0.581)。(3)常規(guī)復查的術(shù)后結(jié)直腸癌患者中非復發(fā)轉(zhuǎn)移者與復發(fā)轉(zhuǎn)移者CTC陽性率分別為51.6%、90.0%,差異有統(tǒng)計學意義(χ~2=9.365,P=0.002)。(4)結(jié)直腸癌患者、結(jié)直腸良性腫瘤患者及健康對照CTC陽性率分別為47.12%、35.3%、0%,差異有統(tǒng)計學意義(χ~2=25.931,P0.001);兩兩比較顯示結(jié)直腸癌患者與結(jié)直腸良性腫瘤患者CTC陽性率未見明顯差異(χ~2=1.538,P=0.215),結(jié)直腸癌患者與健康對照、結(jié)直腸良性腫瘤與健康對照CTC陽性率差異均有統(tǒng)計學意義(分別為χ~2=25.743,P0.001;χ~2=14.571,P0.001)。結(jié)論:治療前CTC檢測可用于評估結(jié)直腸癌患者轉(zhuǎn)移的發(fā)生;而術(shù)后7天進行CTC的檢測尚不能用于手術(shù)療效的評估;常規(guī)復查的術(shù)后1個月內(nèi)未行治療的術(shù)后結(jié)直腸癌患者CTC檢測可用于監(jiān)測結(jié)直腸癌患者的復發(fā)轉(zhuǎn)移;CTC尚不能用于良惡性腫瘤的鑒別,但對結(jié)直腸腫瘤有重要的預警作用,提示患者應該定期隨訪觀察。
[Abstract]:Objective: to evaluate the stage and efficacy of circulating tumor cell CTC in patients with colorectal cancer. Methods to collect 7.5 ml peripheral blood of primary colorectal cancer patients and healthy controls, and to enrich CTC with magnetic beads coated with anti-epithelial cell adhesion molecule EpCAMantibody. The CTC of cytokeratin-positive CK, nuclear staining and leukocyte common antigen negative CD45-were counted, and the relationship between the positive rate of CTC and clinicopathological features of colorectal cancer patients before treatment was analyzed. At the same time, 41 patients who underwent operation were examined for CTC on the 7th day after operation, and the difference of CTC positive rate before and after operation was analyzed. To evaluate the value of CTC in evaluating the curative effect, another group of 82 patients who had undergone colorectal cancer surgery in our hospital and had not received any treatment within one month were examined for CTC. The difference of CTC positive rate between patients with recurrent metastasis and those with non-recurrence and metastasis was analyzed. In addition, 34 patients with colorectal benign tumors were examined by CTC. Results the positive rate of CTC in peripheral blood of patients with colorectal cancer was significantly correlated with the N stage and M stage of colorectal cancer. The positive rates of CTC in N0 / N1 / N2 phase were 38.3% and 37.3% respectively. The positive rates of CTC in M1M 2 phase were 38.0% and 71.1%, respectively. Stage: 蠂 ~ 2 / 6.819 / P ~ (0.033) M: 蠂 ~ (2 / 2) 12.074 / P ~ (0.001); Age, T stage of primary site, platelets, vascular tumor thrombus, natural killer cells, There was no significant difference in regulatory T cells. The statistical results showed that there was no significant difference in the positive rate of CTC before and after operation. (P < 0.05) the positive rates of CTC in patients with non-recurrence and metastasis after operation were respectively higher than those in patients with recurrent and metastatic colorectal cancer. The difference was statistically significant in patients with colorectal cancer (蠂 ~ 2, P = 9.365, P = 0.002, P = 0.002, P < 0.05). The positive rates of CTC in patients with colorectal benign tumors and healthy controls were 47.12 and 35.30.The difference was statistically significant (蠂 ~ 2 ~ 2 ~ (25. 931) ~ (1) P ~ (0.001)), and there was no significant difference in the positive rates of CTC between colorectal cancer patients and benign colorectal cancer patients (蠂 ~ (21) 1.538 P ~ (0.215)), colorectal cancer patients and healthy controls (蠂 ~ (21) 1.538 P ~ (0.215), P < 0.05), the positive rate of CTC in colorectal cancer patients was significantly higher than that in healthy controls (P < 0.05). There were significant differences in CTC positive rates between colorectal benign tumors and healthy controls (蠂 ~ (2) P = 25.743, P 0.001, 蠂 ~ (2) = 14.571) P 0.001.Conclusion: before treatment, CTC detection can be used to evaluate the occurrence of metastasis in patients with colorectal cancer. However, 7 days after operation, the detection of CTC could not be used to evaluate the curative effect of the operation. CTC detection in postoperative colorectal cancer patients who were not treated within 1 month by routine reexamination can be used to monitor the recurrence and metastasis of colorectal cancer patients. CTCs can not be used in the differential diagnosis of benign and malignant tumors, but it plays an important role in the early warning of colorectal cancer. It suggests that patients should be followed up regularly.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.34

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