Detection Of Circulating Tumor Cells On The Perioperative Period In Patients With Non-small-cell Lung Cancer And Its Clinical Significance

Objective:To observe and compare the effects of video-assisted thoracoscopicsurgery (VATS) and conventional thoracotomy on the levels of circulatingtumor cells (CTCs) in patients with non-small-cell lung carcinoma(NSCLC).Methods:Present prospective randomized study.Sixty-three patients with adiagnosis of NSCLC were enrolled in the study. Thirty-three were treatedwith VATS and30were treated with conventional thoracotomy. Bloodsamples (8mL) were collected on the third day prior to surgery(d-3), duringsurgery(d0), and the third day after surgery(d3). After epithelial celladhesion molecule (EpCAM)-immunomagnetic cell enrichment,anti-CK-PE and anti-CD45-FITC fluorescent-labeled monoclonalantibodies were added to sort CTCs. Quantification of CTCs was performedusing multiparameter flow cytometry. Results:(1)The number of CTCs on post-operative day3was significantlyhigher than on pre-operative day3(9.746±13.103vs.4.142±3.971,P=0.002) and on the day of surgery (9.746±13.103VS5.730±4.266，P=0.023) in both groups. The number of CTCs during surgery was alsohigher than on pre-operative day3(5.730±4.266vs.4.142±3.971, P=0.033)in both groups.(2)There was no significant difference in the change of CTCs frombefore surgery to during surgery in the VATS and open thoracotomy groups(1.363±2.924VS1.500±2.315，P=0.329). However, the increase in numberof CTCs from before surgery to after surgery was significantly lower in theVATS group than in the open thoracotomy group (2.181±2.962vs.9.666±15.641, P=0.015).(3)Thirty-seven of the63patients tested positive for CTCs beforesurgery (58.73%). No CTCs were found in10patients with benign lungdiseases and10healthy volunteers.Conclusion:(1)Regardless of the surgical approach, mechanical manipulation of thetumor is inevitable and may lead to the release of tumor cells into theperipheral circulation.(2)Mechanical manipulation of the tumor may cause the disseminationof tumor cells into the circulation, with no significant difference between thetwo surgical approaches. There was a significant difference in the survival of post-operative cancer cells in the circulating blood.(3)A smaller increase in CTCs was seen in patients treated with VATSlobectomy than in patients treated with conventional thoracotomy. Thisreduction in number of post-operative CTCs may improve long-termsurvival.