| 一、Objective:This study aims at making clear the correlation between circulating tumor cell counts(CTC)and the clinicopathoLogistic features along with the overall survival(OS)of patients who are diagnosed with colorectal cancer,lung cancer and nasopharyngeal cancer,which can be detected easily in peripheral blood of these patients.By analyzing its clinical value in tumor diagnosis and condition assessment,this study provides a new strategy for cancer’s treatment,prognosis prediction and progression monitoring.二、MethodsA total amounts of 65 cases of colorectal cancer,65 cases of lung cancer,76 cases of nasopharyngeal carcinoma diagnosed by pathologist were involved in this study.All of the patients were diagnosed and received treatment at Guangzhou First People’s Hospital,Guangzhou Medical University,between January 2014 and December 2017.Thirty healthy donors were also involved as controls.The peripheral blood of the cancer patients were collected and the counts of the CTC were detected before any anti-cancer treatments.We analyze the relationship between the positive rate of CTC and the clinicopathoLogistic features of patients with colorectal cancer,nasopharyngeal carcinoma,or lung cancer.SPASS24.0 statistical software was used for this analysis.The relationships between the positive rate of CTC and clinicopathoLogistic features were analyzed by χ2 test.The survival analysis was performed by log rank test.Multivariate and single factors were analyzed by Cox and Logistic regression.三、Results1.The positive rates of CTC in patients with colorectal cancer,lung cancer,or nasopharyngeal cancer were 76.92%(50/65),70.77%(46/65)and 75.00%(57/76),respectively.And the average positive rate was 74.23%.The positive rate of CTC in normal healthy donors was 0.00%(0/30).The difference between the cancer patients and healthy controls was statistically significant.(P<0.05).2.In 65 cases of colorectal cancer,CTC positive was 50/65(76.92%)before treatment,and 15/60(23.08%)were CTC negative.The relationships between CTC and clinical pathology of colorectal cancer are as follows:(1)There was a significant correlation between CTC and lymph node metastasis in colorectal cancer.The positive rate of CTC in patients with lymph node metastasis(87.80%)was higher than that in patients without lymph node metastasis(58.33%),and the P value was 0.006.There was a significant correlation between CTC and lymph node metastasis in colorectal cancer.The positive rate of CTC in patients with lymph node metastasis(87.80%)was higher than that in patients without lymph node metastasis(58.33%)(P=0.06).(2)There was a significant correlation between CTC and CEA values of colorectal cancer.The higher the CEA value,the higher the positive rate of CTC.The positive rates were 62.96% in CEA<5ng/ml group and 86.84% in CEA≥5ng/ml group(P=0.024).(3)There was no significant correlation between the positive expression of CTC in colorectal cancer and the age,sex,tumor location,tumor size,distant metastasis of colorectal cancer patients(P>0.05).(4)Log-rank survival analysis showed that the overall survival(OS)of CTC-positive patients was significantly shorter than that of CTC-negative patients(P=0.006).Logistic multivariate regression analysis showed that N staging was an independent factor affecting CTC levels(P=0.004),indicating that lymph node metastasis was more likely to lead to CTC positive patients.COX regression revealed that M staging and CTC levels were independent risk factors that affected the prognosis of patients(P<0.05).3.Among the 65 patients with lung cancer,46/65 were CTC positive(70.77%),and 19/65 were CTC negative(29.23%).The relationships between CTC and clinical pathology of lung cancer patients are as follows:(1)The detection rate of CTC in patients with distant metastasis was significantly higher than that in patients without distant metastasis(85.37% vs.54.17%),and the difference was statistically significant(P=0.001).(2)The relationship between CTC counts and serum tumor markers in patients with lung cancer: Cyfra21-1 abnormalities had a high detection rate of CTC,and the positive rates were 30.00% in the Cyfra21-1 ≤ 3.3 ng/ml group and 78.18% in the Cyfra21-1> 3.3ng/ml group.The difference was statistically significant(P=0.002);however,the positive rate of CTC was not significantly associated with the increase of lung cancer CEA(P>0.05).In addition,in small cell lung cancer,the higher the NSE value,the higher the positive rate of CTC,the positive rate were NSE≤25ng/ml group 0.00%,NSE>25ng/ml group 88.89%,the difference was statistically significant(P =0.005)(3)The positive expression of CTC in lung cancer was not significantly associated with age,gender,tissue type,tumor size,and lymph node metastasis in patients with lung cancer(P>0.05).(4)Log-rank survival analysis showed that the overall survival(OS)of lung cancer CTC-positive patients was significantly shorter than that of CTC-negative patients(P=0.002).Logistic multivariate regression analysis results showed that the CTC levels,M-stages and Cyfra211 abnormalities could be used as prognostic factors.Patients with distant metastasis and elevated Cyfra21-1 have a high positive rate of CTC.Logistic multivariate regression analysis showed that M staging and Cyfra21-1 abnormalities were independent influencing factors of CTC levels(P < 0.05);COX regression revealed that distant metastasis and CTC positive were independent risk factors affecting patients’ prognosis(p < 0.05).4.Of the 76 patients with nasopharyngeal disease,57/76 were CTC positive(75.00%)and 19/76 were CTC negative(25.00%).The relationships between CTC and clinicopathoLogistic parameters of nasopharyngeal carcinoma are as follows:(1)There was significant difference between the CTC positive rate and the T staging(T1-2/T3-4)(P=0.034),but there was no significant difference with N stage(P=0.235).(2)The detection rate of CTC in NPC patients with distant metastasis was significantly higher than that in patients without distant metastasis(70.77% vs.100.00%).The difference was statistically significant(P=0.038).(3)There was no significant correlations between CTC and age,sex,histoLogistic type,lymph node metastasis,and VCA-IgA in patients with nasopharyngeal carcinoma(P>0.05).(4)Log-rank survival analysis showed that overall Survival(OS)was significantly shorter in CTC-positive patients than in CTC-negative patients(P=0.018).Logistic multivariate regression analysis showed that tumor invasion was an independent factor of CTC level(P < 0.05).四、Conclusion1.Compared with healthy individuals,there is indeed malignant cell infiltration in the peripheral blood of patients with colorectal cancer,lung cancer,and nasopharyngeal cancer.The detection of peripheral blood CTC can provide auxiliary parameters for the diagnosis of colorectal cancer,lung cancer,and nasopharyngeal cancer.2.The expression of CTC is associated with stages,metastasis,and tumor markers.Besides,the CTC combining with common conventional tumor markers provide better tumor diagnosis,better clinical staging accuracy,and better understanding of progression.3.By detecting the expression of CTC in peripheral blood of cancer patients,it provides an effective method for evaluating the survival prognosis and disease progression of patients. |
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