| ObjectiveThe purpose of this study is to explore the relation of CTC and advanced gastric cancer associated tumor markers,and assess the possibility of doing it as an index of curative effect of advanced gastric cancer chemotherapy.By the method of membrane filtration to shunt tumor cells,then detect the CTC in the peripheral blood after chemotherapy,find out the positive rate of CTC and analyze the contact with CTC and the clinical features(include tumor differentiation 、 TNM stage 、 depth of invasion、distant metastasis and lymphatic metastasis,etc.).Methods1、We enrolled 44 patients who were confirmed by pathology confirmed advanced gastric cancer and were admitted by Fujian Medical University Union Hospital between September 2015 and April 2016.Peripheral blood samples were collected within one week after chemotherapy.All of the above have been granted the full informed consent of patients,and signed the informed consent forms with the approval of Ethics Committee of Union Hospital2、The ISET method was used to enrich CTC.CTC were trapped on the microporous filter membrane according to the differences of cell size、deformability and fluidity and so on between CTC and normal blood cells.After that the cells retained on the membrane were stained by Diff-Quick.The result can be read under the optical microscope after attaching the filter to the pathological slides.3、All data were analyzed using SPSS 19.0,and t-test/variance analysis or chi-square test was used to compare the differences between groups.All the test data were used bilateral test,P value less than 0.05 was statistically significant.(P<0.05)Results1、CTC ≥4/5ml was defined as CTC positive,CTC<4/5ml was negative,among them 17 cases were positive.2、We found that the positive rate of CTC was closely related to the degree of tumor differentiation(P=0.040).The difference was statistically significant.The detection rate was significantly correlated with age,sex,incidence of gastric cancer,clinical TNM stage,depth of invasion,lymphatic metastasis,distant metastasis,with or without tumor thrombus,whether the surgery were found no significant difference.(P >0.05)3、The difference of the value of CA724 between CTC positive group and CTC negative group was statistically significant(P<0.05),while that of CA199、CEA was not statistically significant(P>0.05).4、According to the chemotherapy regimens,44 patients with advanced gastric cancer can be divided into 4 groups: fluoropyrimidine + platinum group、fluorouracil group、taxane group and irinotecan group,there were no statistically significant differences between groups in CTC positive rates.On the basis of curative effect evaluation standard,these 44 patients were divided into 2 groups: CR/PR/SD group and PD group.There were 23 patients in the CR/PR/SD group and 5 patients among them were CTC positive(21.7%).Another 21 patients were in the PD group and 12 patients were positive(57.1%).There was a significant difference in the positive rates of CTC between these 2 groups(P=0.029).Conclusions1、Application of ISET technology to monitor CTC in peripheral blood can exclude the interference from EMT-derived CTC,increase the sensitivity of detection and improve the detection rate.2、Among these 44 patients with advanced gastric cancer,the CTC positive rate in the poorly differentiated group was significantly higher than that in high-middle differentiated group,the difference was statistically significant.3、The CA724 level was positively correlated with the positive rate of CTC in peripheral blood of the patients with advanced gastric cancer.The combination of these two indexes could be used as a factor in the prognosis of patients with advanced gastric cancer and the evaluation of adjuvant chemotherapy.4、The effect of adjuvant chemotherapy on advanced gastric cancer is related to the positive rate of CTC.The patients who have a large amount of CTC may be more prone to drug resistance and poor prognosis.To detect the CTC level can assist in assessing the efficacy of chemotherapy. |
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