CEA-Antigen and SCC-Antigen mRNA Expression in Peripheral Blood Predict Hematogenous Recurrence After Resection in Patients with Esophageal Cancer
CEA-Antigen and SCC-Antigen mRNA Expression in Peripheral Blood Predict Hematogenous Recurrence After Resection in Patients with Esophageal Cancer
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DOI：
10.1245/s10434-010-1075-3
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发表时间：
2010-10-01
影响因子：
3.7
通讯作者：
Ishikawa, Osamu
中科院分区：
文献类型：
--
作者：
Tanaka, Koji;Yano, Masahiko;Ishikawa, Osamu
背景虽然一些研究表明循环肿瘤细胞（CTC）和食管癌手术后的预后之间的关联，但缺乏大规模的研究。本研究的目的是前瞻性地研究CTC和结果之间的相关性，在大量的患者接受食管切除术。前瞻性分析了2002年至2007年间接受根治性手术的244例食管鳞状细胞癌患者术前和术后的CTC。采用逆转录-聚合酶链反应（RT-PCR）检测癌胚抗原（CEA）和鳞状细胞癌（SCC）抗原mRNA。结果：CTC以至少检测到1种肿瘤标志物mRNA为阳性。术前CTC阳性34例（13.9%），术后CTC阳性41例（16.8%）。多变量分析确定肿瘤深度（风险比[HR]，0.439; 95%置信区间[95% CI]，0.268-0.722; P = 0.0012），淋巴结转移（HR，2.467; 95% CI，1.436-4.237; P = 0.0011），静脉侵犯（HR，1.802; 95% CI，1.082-3.002; P = 0.0236）和胸外科手术后的CTC状态（HR，1.647; 95%CI，1.032-2.629; P = 0.0365）作为无病生存的独立预后因素。CTC（+）组术后血行性（P = 0.0222）和局部（P = 0.0464）复发率明显高于CTC（-）组。新辅助化疗的应答者在胸部手术后显示淋巴管浸润较少，CTC阳性率较无应答者降低。胸外科手术后CTC状态是食管癌患者血行性和局部复发的有用预测因子。
Background. Although several studies have suggested an association between circulating tumor cells (CTC) and prognosis after esophageal cancer surgery, large-scale studies are lacking. The aim of this study was to prospectively examine the correlation between CTC and outcome in a large number of patients who underwent esophagectomy.Materials and Methods. A cohort of 244 patients with squamous cell carcinoma of the esophagus who underwent curative surgery between 2002 and 2007 were prospectively analyzed for CTC before surgery and after the thoracic procedure. Reverse transcription-polymerase chain reaction for CEA and SCC antigen mRNA was used to detect cancer cells in the peripheral blood. CTC was defined as positive when at least 1 tumor marker mRNA was detected.Results. CTC was positive in 34 patients (13.9%) before surgery and in 41 patients (16.8%) after the thoracic procedure. Multivariate analysis identified tumor depth (hazard ratio [HR], 0.439; 95% confidence interval [95% CI], 0.268-0.722; P = 0.0012), lymph node metastasis (HR, 2.467; 95% CI, 1.436-4.237; P = 0.0011), venous invasion (HR, 1.802; 95% CI, 1.082-3.002; P = 0.0236), and CTC status after the thoracic procedure (HR, 1.647; 95% Cl, 1.032-2.629; P = 0.0365) as independent prognostic factors of disease-free survival. The rates of hematogenous (P = 0.0222) and local (P = 0.0464) recurrences were significantly higher in patients with CTC(+) after the thoracic procedure than those with CTC(-) after the thoracic procedure. Responders to neoadjuvant chemotherapy showed less lymphatic invasion and a decreased positive CTC rate after the thoracic procedure than nonresponders.Conclusions. CTC status after the thoracic procedure is a useful predictor for hematogenous and local recurrences in patients with esophageal cancer.