Research on the prediction of hematogenous metastasis and recurrence of hepatocellular carcinoma, pancreatic carcinoma, gastric carcinoma and esophageal carcinoma. (Detection of circulating AFPmRNA,CEAmRNA and Cytokeratin mRNA)

在本研究中，我们建立了血液中多种胃肠道癌细胞的检测体系(RT-Nest-PCR)，其中甲胎蛋白(AFP)mRNA用于肝细胞癌，癌胚抗原(CEA)用于胰腺癌和胃癌，细胞角蛋白(CK20)用于结直肠癌，鳞状细胞癌抗原(SCC)用于食道癌。这些系统可以在1ml的血液中检测到一到五个癌细胞，磁性细胞吸附后免疫组织化学清楚地显示细胞在外周血中表达CEA或细胞角蛋白。我们还检测了胰腺癌患者术中门静脉CEA mRNA和食道癌患者术中外周血SCC mRNA。这些事实表明，肿瘤细胞在手术过程中可以在血液中扩散，血液中肿瘤相关基因的检测与患者的预后和复发密切相关。也有患者化疗后未检测到CEA或SCC基因的表达，但给药方案仍存在争议。我们的血液癌细胞检测系统有助于预测患者的预后，并可能为化疗策略提供有益的信息。对血液中癌细胞阳性患者的临床病理及分子生物学分析有待进一步研究。

In this study, we established detection system (RT-nested PCR) of various gastrointestinal carcinoma cells in blood in the form of following mRNA.Alpha-fetoprotein(AFP) mRNA for hepatocellular carcinoma, carcinoembrionic carcinoma antigen (CEA) mRNA for pancreatic and gastric carcinoma, cytokeratin 20mRNA for colorectal carcinoma, and squamous cell carcinoma antigen (SCC) mRNA for esophageal carcinoma These systems could detect one to five cancer cells in 1ml of blood and magnetic cell absorption followed by immunohistochemistry clearly demonstrated the cells, which express CEA or Cytokeratin in peripheral blood. We also detected CEA mRNA in portal vein during operations in pancreatic carcinoma patients and SCC mRNA in peripheral blood during operations in patients with esophageal carcinoma. These facts show that carcinoma cells can be disseminated in blood during operations.Detection of carcinoma related mRNAs in blood correlated with patients prognosis and recurrence. There were patients whose CEA mRNA or SCC mRNA was not detected after chemotherapy, however the protocols of drug administration remains controversial. Our detection systems of cancer cells in blood are useful for prediction of patients' prognosis and might have beneficial information for strategy of chemotherapy. Clinicopathological as well as molecular biological analysis of the patients with positive cancer cells in blood should be evaluated in the future.