Study of hematogenous micrometastases by RT-nested PCR of CEA mRNA in patients with esophageal cancer receiving chemoradiotherapy

导语：食道癌是一种高度致命的疾病。最近报道的放化疗(CRT)结果表明，这种治疗方法在治疗晚期食道癌方面具有多种优势。在早期阶段，明确的CRT和手术切除提供了良好的结果。在疾病的晚期，新辅助CRT再手术可改善原发肿瘤的可切除性和总存活率。然而，一些患者在手术后不久就因远处扩散而死亡。这些患者在手术切除前可能已经有微转移。因此，及早发现微转移是一个至关重要的问题。本研究试图通过RT-PCR检测食管癌CRT患者CEA mRNA的血行微转移情况，并评价其临床意义。方法：对2001~2004年在我校接受CRT的55例食管癌患者进行研究。55例患者中有33例在…后接受了手术更多的是呃CRT。分别于CRT术前、术后及术后抽取外周静脉血样。从每个血样中提取总RNA后，进行CEA特异性逆转录套式聚合酶链式反应。结果：CRT前CEA mRNA表达阳性率为52.7%(29/55)。CRT前CEA信使核糖核酸与淋巴结转移和临床分期相关。CRT后CEA mRNA阳性表达例数减少(41.8%，23/55)。6例术后CEA mRNA表达也发生改变，5例转为阴性，1例转为阳性。结论：CEA mRNA是检测食道癌患者外周血微转移的敏感、特异的分子标志物。它可以帮助预测食道癌最终治疗后的预后，并确定哪些患者将受益于积极的辅助治疗。较少

Introduction : Esophageal cancer is a highly virulent disease. Recent reported results of chemoradiotherapy (CRT) have indicated various advantages of this treatment against advanced esophageal cancer. In early stages, definitive CRT as well as surgical resection provide good results. In advanced stages of the disease, neo-adjuvant CRT followed by surgery improve primary tumor resectability and overall survival. However, some patients die due to distant spread shortly after surgery. Those patients may already have had micrometastases before surgical resection. Thus, early detection of micrometastasis is an issue of utmost importance. In this study, we attempted to detect hematogenous micrometastasis by RT-PCR of CEA mRNA in patients with esophageal cancer receiving CRT and evaluated the clinical significance.Methods : A total of 55 esophageal cancer patients who underwent CRT in our university hospital between 2001 and 2004 were studied. Thirty-three of 55 patients received surgery aft … More er CRT. Blood samples were aspirated from peripheral vein at pre- and post-CRT, and post-surgery. After total RNA was extracted from each blood sample, CEA-specific RT-nested PCR was performed. All patients were followed-up for one year.Results : The positive expression of CEA mRNA before CRT was 52.7% (29/55). CEA mRNA before CRT correlated with lymph node metastasis and clinical stage. The number of cases with positive expression of CEA mRNA decreased after CRT (41.8%, 23/55). The expression of CEA mRNA also changed after surgery in 6 patients ; 5 patients became negative and one patient became positive. Expression of CEA mRNA after final treatments correlated recurrence and a poor prognosis.Conclusion : CEA mRNA is a sensitive and specific molecular marker for detection of micrometastasis in peripheral blood of patient with esophageal cancer. It can help to predict the prognosis of esophageal cancer after final treatment, and to determine which patient will benefit from aggressive adjuvant therapies. Less