Molecular detection of circulating tumor cells by reverse transcriptase-polymerase chain reaction in patients with non-small cell lung cancer: A prospective study for clinical significance of micrometastasis

应用癌胚抗原(CEA)基因逆转录聚合酶链式反应(RT-PCR)检测可切除非小细胞肺癌(NSCLC)患者外周血中是否存在循环肿瘤细胞。我们对103例接受根治性肺叶切除术的非小细胞肺癌患者分别于术前诊断时和术后2~3周采集外周血，用RT-PCR方法检测CEA基因的表达。取自15例接受开胸肺活检的间质性肺纤维化患者和32例健康受试者的血液作为对照。RT-PCR检测无一例对照标本CEA阳性。103例非小细胞肺癌患者术前血标本中有62例(60.2%)阳性。在62例患者中，27例(43.5%)术后仍为阳性，其余35例(56.5%)转为阴性。CEA mRNA阳性率与手术前后…的病理TNM分期高度相关更多的莱斯。许多可切除的NSCLC患者即使在手术后也能检测到表达癌胚抗原的循环细胞水平。接下来，我们对103名接受根治性肺叶切除术的NSCLC患者进行了前瞻性研究，以测试在NSCLC患者中，通过CEA mRNA的RT-PCR检测到的外周血中循环肿瘤细胞是否为独立于肿瘤分期的预后指标。CEA信使核糖核酸阳性患者的生存率明显低于CEA信使核糖核酸阴性患者，其中术后CEA信使核糖核酸阳性患者的生存率最低。多因素逐步回归分析筛选出影响预后的独立预后因素为术前CEA基因表达和病理分期。术前外周血CEA mRNA分子检测是非小细胞肺癌根治性手术后独立的预后因素。较少

We tested whether circulating tumor cells can be detected in the peripheral blood of patients with resectable non-small cell lung cancer (NSCLC) by reverse transcriptase-polymerase chain reaction (RT-PCR) of carcinoembryonic antigen (CEA) mRNA. We assayed for CEA mRNA by RT-PCR in the peripheral blood taken at the time of diagnosis before surgery and again 2 to 3 weeks after surgery from 103 patients with NSCLC who underwent a curative lobectomy. Blood taken from 15 patients with interstitial pulmonary fibrosis who underwent an open-lung biopsy and 32 healthy subjects served as controls. No control samples were positive for CEA by RT-PCR. Sixty-two (60.2%) of the preoperative blood samples from the 103 patients with NSCLC were positive. Of these 62, 27 (43.5%) remained positive even after surgery, while the remaining 35 (56.5%) became negative. The incidence of positive CEA mRNA correlated highly with pathologic TNM stage of disease both in the preoperative and postoperative blood samp … More les. Many patients with resectable NSCLC have detectable levels of circulating cells expressing carcinoembryonic antigen even after surgery. Next, we conducted a prospective study of 103 consecutive patients with NSCLC who underwent a curative lobectomy to test whether circulating tumor cells detected in the peripheral blood by RT-PCR of CEA mRNA is a prognostic indicator independent of tumor stage in patients with NSCLC. Patients with positive CEA mRNA in the preoperative blood samples had a poor survival when compared to those with negative CEA mRNA; of these patients, the worst survival rate was seen in those with positive CEA mRNA in the postoperative blood samples. The multivariate stepwise analysis selected the preoperative CEA mRNA expression and the pathologic stage of disease as the independent prognostic factors for survival. The molecular detection of CEA mRNA in the preoperative peripheral blood is an independent prognostic factor in patients with NSCLC who undergo a curative surgery. Less