外周血循环肿瘤细胞和肿瘤标志物在评估老年非小细胞肺癌患者化疗后疗效中的价值

doi:10.3969/j.issn.1006-6233.2021.05.017

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摘要 目的: 探讨外周血循环肿瘤细胞(CTCs)和肿瘤标志物在评估老年非小细胞肺癌(NSCLC)患者化疗后疗效中的价值。方法: 选取2017年9月至2019年2月期间于我院收治的86例经病理检查证实的老年NSCLC患者作为研究对象,均接受多西他赛+顺铂化疗,检测化疗前外周血CTCs和血清神经元特异性稀醇化酶(NSE)、细胞质胸苷激酶-1(TK-1)和中期因子(MK)水平,评估患者治疗6个月后的临床疗效,并采用单因素、多因素Logistic回归分析以及ROC曲线分析外周血CTCs和血清NSE、TK-1、MK对老年NSCLC患者化疗后疗效的评估价值。结果: 化疗后,49例治疗有效,治疗总有效率为56.98%,为治疗有效组;37例(43.02%)患者治疗无效,为无效组。经检测,无效组血清NSE、TK-1、MK水平和CTCs阳性率均明显高于有效组(P<0.05),且CTCs阳性率与血清NSE、TK-1、MK的表达存在明显的正相关性(P<0.05)。单因素分析结果显示,两组在肿瘤TNM分期、外周血CTCs、血清NSE、TK-1、MK表达方面存在明显差异(P<0.05);多因素回归分析结果显示,外周血CTCs阳性、NSE≥40.0ng/mL、TK-1≥4.5pmoL/L和MK≥0.8ng/mL是老年NSCLC患者化疗后无效的独立预测因素;ROC曲线分析结果显示,血清NSE、TK-1、MK单独预测老年NSCLC患者化疗后无效的ROC曲线下面积均低于三指标联合预测的ROC曲线下面积(P<0.05)。结论: 外周血CTCs高阳性表达率和血清NSE、TK-1、MK高表达是NSCLC患者化疗后无效的重要影响因素,且血清三项联合检测对于评估NSCLC患者化疗后疗效具有较好的应用价值。

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	李晓华
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关键词 ：非小细胞肺癌, 外周血循环肿瘤细胞, 神经元特异性稀醇化酶, 细胞质胸苷激酶-1, 中期因子, 疗效评估

Abstract：Objective: To explore the value of circulating tumor cells (CTCs) and tumor markers in peripheral blood for evaluating the curative effect on elderly patients with non-small cell lung cancer (NSCLC) after chemotherapy. Methods: A total of 86 elderly NSCLC patients admitted to the hospital from September 2017 to February 2019 and confirmed by pathological examination were enrolled as the research subjects. All underwent chemotherapy with docetaxel and cisplatin. The levels of CTCs in peripheral blood, serum neuron specific enolase (NSE), cytoplasmic thymidine kinase-1 (TK-1) and midkine (MK) were detected before chemotherapy. The clinical curative effect after 6 months of treatment was evaluated. The evaluation value of peripheral blood CTCs, serum NSE, TK-1 and MK for curative effect on elderly NSCLC patients after chemotherapy was analyzed by univariate analysis, multivariate Logistic regression analysis and ROC curve analysis. Results: After chemotherapy, there were 49 cases (56.98%) effective, who were included into effective group, and there were 37 cases (43.02%) ineffective, who were included into ineffective group. After test, levels of serum NSE, TK-1 and MK, and positive rate of CTCs in ineffective group were significantly higher than those in effective group (P<0.05). The positive rate of CTCs was significantly positively correlated with the expression of serum NSE, TK-1 and MK (P<0.05). The results of univariate analysis showed that there were significant differences in TNM staging of tumors, peripheral blood CTCs, serum NSE, TK-1 and MK between the two groups (P<0.05). The results of multivariate regression analysis showed that positive peripheral blood CTCs, serum NSE not lower than 40.0 ng/ml, TK-1 not lower than 4.5 ng/ml and MK not lower than 0.8 ng/ml were independent predictors of ineffective curative effect on elderly NSCLC patients after chemotherapy. The results of ROC curve analysis showed that area under the ROC curve (AUC) of serum NSE, TK-1 and MK alone for predicting ineffective curative effect on elderly NSCLC patients after chemotherapy was lower than that of their combination (P<0.05). Conclusion: The high positive expression rate of peripheral blood CTCs, and high expression of serum NSE, TK-1 and MK are important influencing factors of ineffective curative effect on elderly NSCLC patients after chemotherapy. The combined detection of the three is of good application value in evaluating the curative effect on elderly NSCLC patients after chemotherapy.

Key words： Non-small cell lung cancer Circulating tumor cell in peripheral blood Neuron specific enolase Cytoplasmic thymidine kinase-1 Midkine Evaluation of curative effect

基金资助:四川省教育厅科研项目,(编号:SWFZ18-Q-9)

通讯作者: 唐军伟

引用本文:

李晓华, 李洁, 唐军伟. 外周血循环肿瘤细胞和肿瘤标志物在评估老年非小细胞肺癌患者化疗后疗效中的价值[J]. 河北医学, 2021, 27(5): 779-785.
LI Xiaohua, LI Jie, TANG Junwei. Value of Circulating Tumor Cells and Tumor Markers in Peripheral Blood for Evaluating the Curative Effect on Elderly Patients with Non-Small Cell Lung Cancer After Chemotherapy. HeBei Med, 2021, 27(5): 779-785.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.05.017 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I5/779

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