| Objective:To analyze the relationship between the number and classification of circulating tumor cells(CTCs)in peripheral blood and PTEN genotypes and clinical features in patients with stage Ⅲ colorectal cancer after operation,and to explore the relationship between clinical significance of CTCs and prognosis.Methods:77 patients with newly diagnosed colorectal cancer were collected and drawed blood from the elbow vein before eating in the morning after operation and before chemotherapy.Peripheral venous blood 7.5ml was prepared for detection of CTCs(including CTC quantity,classification)in peripheral blood of patients.The expression levels of PTEN genes in various types of CTC were detected.To analyze the relationship between the results of CTC and the clinical and pathological features of patients(including sex,age,degree of differentiation,stage,location of occurrence,perforation or bleeding,obstruction),and its relationship with prognosis.The relationship between CTCs positive rate,clinical and pathological features was analyzed byχ~2 test,Fisher exact probability test or rank sum test,and the overall survival was compared by Kaplan Meier curve and Cox proportional hazard model.Results:(1)There was no significant correlation between CTCs classification and age,sex,tumor location and history of hematochezia/obstruction.The difference of CTC epithelial type in different differentiation degree was statistically significant(P<0.05).There were significant differences in the total number of CTC,epithelial type and mixed type in different T score periods(P<0.05),but the difference of interstitial type in different T scores was not statistically significant.(P>0.05).there was significant difference in mixed type in different N score periods(P<0.05).There was no significant difference between the total CTC and epithelial and interstitial types during the N score period(P<0.05).(2)Relationship between PTEN gene expression and clinical characteristics in CTCs positive patients:There was significant difference in the expression of PTEN between patients with N stage and tumor progression(P<0.05),the expression of PTEN in N1 stage was significantly higher than that in N2 stage。The progression rate of patients without PTEN expression was significantly increased,while that of patients with PTEN expression was significantly lower.(3)The influencing factors of DFS of postoperative patients in Ⅲ stage colorectal cancer:DFS was related to age,obstruction,PTEN,CTC,etc.The tumor occurred with obstruction symptoms,postoperative CTC positive,CTC cell PTEN negative patients’DFS was relatively worse,the difference was statistically significant(P<0.05).Multivariate analysis showed that the higher the PTEN,the younger the age,the lower the probability of progression in patients without obstruction and CTCs negative patients.(4)Influencing factors of postoperative OS in Ⅲ stage colorectal cancer:univariate analysis showed that OS was related to N stage,hematochezia,PTEN expression status,but not to gender,tumor location,T stage,tumor differentiation and obstruction.The survival rates of hematochezia,stage N2 and PTEN were significantly higher,and the difference was statistically significant(P<0.05).Multivariate analysis showed that PTEN gene could significantly affect the survival rate of patients with higher OS,PTEN.Conclusion:The expression levels of CTC,PTEN genes may reflect the metastatic abi lity of colorectal tumor cells and serve as an index to judge the prognosis of colorectal cancer.(1)CTCs typing was correlated with genotyping and differentiation,T stage,N stage and tumor progression.(2)Positive expression of PTEN,less than 65 years old,no obstruction and negative CTCS are independent factors for good prognosis of postoperative DFS in stage Ⅲ colorectal cancer.(3)The condition of PTEN gene can significantly affect OS.The higher the PTEN,the higher the survival rate. |
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