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

我们采用癌胚抗原（CEA） mRNA逆转录聚合酶链反应（RT-PCR）检测可切除非小细胞肺癌（NSCLC）患者外周血中循环肿瘤细胞的检测。我们通过RT-PCR检测了103例接受根治性肺叶切除术的非小细胞肺癌患者术前和术后2 - 3周外周血中CEA mRNA的含量。15例间质性肺纤维化患者接受开肺活检，32名健康受试者作为对照。对照样品经RT-PCR检测均无CEA阳性。103例NSCLC患者术前血液样本中62例（60.2%）呈阳性。在这62例患者中，27例（43.5%）术后仍呈阳性，其余35例（56.5%）呈阴性。在术前和术后血样本中，CEA mRNA阳性的发生率与病理TNM分期高度相关。许多可切除的非小细胞肺癌患者甚至在手术后仍可检测到表达癌胚抗原的循环细胞水平。接下来，我们对103例连续行根治性肺叶切除术的非小细胞肺癌患者进行了前瞻性研究，以检验通过CEA mRNA的RT-PCR检测外周血循环肿瘤细胞是否是非小细胞肺癌患者独立于肿瘤分期的预后指标。术前血液样本中CEA mRNA阳性的患者与CEA mRNA阴性的患者相比，生存率较低；在这些患者中，术后血液样本中CEA mRNA阳性的患者生存率最差。多因素逐步分析选择术前CEA mRNA表达和疾病病理分期作为独立的预后因素。术前外周血中CEA mRNA的分子检测是行根治性手术的非小细胞肺癌患者的独立预后因素。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