The Effects To Circulating Tumor Cells Of Two Different Treatments For Pancreatic Cancer

Introduction:Most of pancreatic cancer patients were in the middle and late stage when theywere diagnosed. The five-year-survival rate of pancreatic cancer is less than6%, themedian survival time is only three to four months. Although huge progresses have beenmade in the treatment, the prognosis is still uncertain. The five-year-survival rate of thepatients after radical surgery is less than20percent. Metastasis and relapse is the majorcause of treatment failure.In pancreatic cancer patients, the most important reason forthe failure may be micro-metastasis in blood circulation which cannot be found by thecurrent examination method during the treatment.Only a small part of tumor cells in thecirculation can survive and gather into clusters, which can invade the blood vessel andform new neoplasm in distant sites. The test and analysis of CTCs is a new and effectivenoninvasive method in early diagnosis, prognosis and treatment response for pancreaticcancer.Objective:The purpose of this study is to explore the effects to the hematogenous metastasisof tumor cells with treatment of HIFU ablation and open surgery, provide clinical basisfor reasonable therapeutic schedule, through testing the changes of CTCs before andafter treatment.Methods:Choose48patients met the inclusion criteria who were in hospital from October2012to December2013.All the patients were diagnose by pathology before treatment.Informed consents are signed before HIFU or surgery. The48patients were randomly divided into HIFU group (I group, n=24) and open surgery group (II group,n=24).Collecting peripheral venous blood5ml in morning fasting condition at the time24hour before HIFU or surgery and24hour after HIFU or surgery,then immune beadsnegative enrichment gathering with immune fluorescence in situ hybridization areapplicated to test the CTCs levels in peripheral blood. SPSS20.0statistical software foranalysis and processing of data.Results:There was no significant difference in clinicopatholoic characteristics betweenthese two groups.In the surgical resection，the positive rate of CTC before and aftersurgery were(0/24)and33.33％(8/24)(P=0.002)，8patients had increasedmicrometastatic risk related to surgery；In the HIFU-group，the positive rate of CTCbefore and after surgery were (0/24) and8.33％(2/24)(P=0.149)，respectively，and2patients had increased micrometastatic risk related to surgery．The results showed ahigher clinical and statistical elevation in postoperative CTC detection rate and medianlevels in the surgical resection compared wlth the HIFU．An increased micrometastaticrisk caused by operation was observed in the surgical resection as compared to theHIFU approach(OR：2=4.547，P=0.033，OR=1.900，95％CI1.170-3.085)，and thedifference of micrometastatic risk related to treatments between these two groupscorrelated with the status of lymph node，not the status of age, sex, tumor staging,degree of tumor differentiation, tumor position．Conclusion:1.Open surgery and HIFU could provoke the iatrogenic hematogenousdissemination of pancreatic carcinoma cell，and there is an increased micrometastaticrisk from treatment in the open surgery as compared to the high intensity focusedultrasound ablation.2. After open surgery or HIFU ablation, chemotherapy and immunotherapy asadjuvant therapy should be applied in treating pancreatic cancer patients appropriatly.3.The change of CTCs after treatment of open surgery or HIFU ablation is relate tolymph node metastasis, after open surgery or HIFU ablation, pancreatic cancer patientswho were with lymph node metastasis should be given combied modality therapy，such as chemotherapy and immunotherapy.