三阴性乳腺癌患者CTCs阳性率及其与近期生存率的关系-东南大学学报医学版

三阴性乳腺癌患者CTCs阳性率及其与近期生存率的关系

单位：南阳市第二人民医院乳腺肿瘤科, 河南南阳 473000

分类号：R737.9

出版年·卷·期（页码）：2025·44·第四期（541-548）

摘要：

目的:检测三阴性乳腺癌患者循环肿瘤细胞(CTCs)水平,并探讨其与近期生存率的关系。方法:选取2018年3月至2020年12月本院收治的128例三阴性乳腺癌患者作为研究对象,检测患者空腹静脉血CTCs,并比较不同临床病理特征三阴性乳腺癌患者CTCs阳性率。绘制Kaplan-Meier生存曲线分析三阴性乳腺癌患者生存情况,比较生存组和死亡组临床资料,采用单因素和多因素Cox回归模型分析三阴性乳腺癌患者3年生存率的影响因素,并绘制受试者工作特征(ROC)曲线分析CTCs对三阴性乳腺癌近期生存的预测价值。结果:128例三阴性乳腺癌患者3年生存率为79.69%。三阴性乳腺癌患者CTCs阳性率为61.72%(79/128),最大肿瘤直径≥3 cm、有淋巴结转移、肿瘤-淋巴结-转移(TNM)分期Ⅲ期三阴性乳腺癌患者的CTCs阳性率更高(P＜0.05)。CTCs阳性(HR=3.877,95%CI:1.685~8.918)、有淋巴结转移(HR=3.254,95%CI:1.477~7.169)、TNM分期Ⅲ期(HR=4.108,95%CI:1.854~9.104)是影响三阴性乳腺癌患者3年生存率的危险因素,化疗(HR=0.462,95%CI:0.255~0.838)是其保护因素(P＜0.05)。CTCs预测三阴性乳腺癌患者近期生存的灵敏度为84.62%,特异度为44.12%,曲线下面积为0.644(95%CI:0.554~0.726)。结论:三阴性乳腺癌患者CTCs阳性率与肿瘤直径、淋巴结转移、TNM分期相关,是影响三阴性乳腺癌患者3年生存率的危险因素,可作为监测三阴性乳腺生存预后的血清标志物。

Objective: To detect the level of circulating tumor cells(CTCs) in patients with triple negative breast cancer, and explore the relationship between them and short-term survival rate. Methods: 128 triple negative breast cancer patients admitted to our hospital from March 2018 to December 2020 were selected as the study subjects, and the positive rate of CTCs was detected. The positive rates of CTCs in triple negative breast cancer patients with different clinical pathological characteristics were compared. Kaplan-Meier survival curve was drawn to analyze the survival of triple negative breast cancer patients. The clinical data of the survival group and the death group was compared. The influencing factors of 3-year survival rate of triple negative breast cancer patients were analyzed by single factor and multi factor Cox regression models. And the predictive value of CTCs on short-term survival of triple negative breast cancer was analyzed using the receiver operating characteristic curve. Results: The 3-year survival rate of 128 triple negative breast cancer patients was 79.69%. The positive rate of CTCs in triple negative breast cancer patients was 61.72%(79/128). The positive rates of CTCs in triple negative breast cancer patients with the largest tumor diameter ≥3 cm, lymph node metastasis, and tumor-node-metastasis(TNM) stage Ⅲ were higher(P<0.05). The 3-year survival rates of breast cancer patients with positive CTCs, lymph node metastasis, TNM stage Ⅲ, having no triple negative chemotherapy were lower(P<0.05). Positive CTCs(HR=3.877, 95%CI:1.685-8.918), lymph node metastasis(HR=3.254, 95%CI:1.477-7.169), and TNM stage Ⅲ(HR=4.108, 95%CI:1.854-9.104) were risk factors affecting the 3-year survival rate of triple negative breast cancer patients, while chemotherapy(HR=0.462, 95%CI:0.255-0.838) was a protective factor(P<0.05). The sensitivity of CTCs in predicting the short-term survival of triple-negative breast cancer was 84.62%, the specificity was 44.12%, and the area under the curve was 0.644(95%CI:0.554-0.726). Conclusion: The positive rate of CTCs in triple negative breast cancer patients is related to tumor diameter, lymph node metastasis and TNM stage. It is a risk factor affecting the 3-year survival rate of triple negative breast cancer patients, and it is expected to become a serum marker for monitoring the survival prognosis of triple negative breast cancer.

参考文献：

[1] 雷少元,郑荣寿,张思维,等.乳腺癌发病率和死亡率的全球模式:一项基于人群的2000—2020年肿瘤登记数据分析研究[J].癌症,2022,41(7):324-335.
[2] ZHU Y,TAO L F,LIU J Y,et al.Construction of a prognostic model for triple-negative breast cancer based on immune-related genes,and associations between the tumor immune microenvironment and immunological therapy[J].Cancer Med,2023,12(14):15704-15719.
[3] ALBUSAYLI R,GRAHAM J D,PATHMANATHAN N,et al.Artificial intelligence-based digital scores of stromal tumour-infiltrating lymphocytes and tumour-associated stroma predict disease-specific survival in triple-negative breast cancer[J].J Pathol,2023,260(1):32-42.
[4] 唐朝贤,龚靖淋,张倩.循环肿瘤细胞液体活检技术研究现状及应用前景[J].现代医学,2023,51(1):115-120.
[5] KOCH C,KUSKE A,JOOSSE S A,et al.Characterization of circulating breast cancer cells with tumorigenic and metastatic capacity[J].EMBO Mol Med,2020,12(9):e11908.
[6] 王浩,李南林,曹海玲.循环肿瘤细胞与三阴性乳腺癌预后及肿瘤状态的关系分析[J].实用临床医药杂志,2023,27(18):39-43.
[7] 中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志,2017,27(9):695-759.
[8] HOWARD F M,OLOPADE O I.Epidemiology of triple-negative breast cancer:a review[J].Cancer J,2021,27(1):8-16.
[9] 傅爱荣,江美芳,余滕骅,等.三阴性乳腺癌患者短期预后的影响因素分析[J].中国医学创新,2023,20(14):143-147.
[10] SABATH D E,PERRONE M E,CLEIN A,et al.Clinical validation of a circulating tumor cell assay using density centrifugation and automated immunofluorescence microscopy[J].Am J Clin Pathol,2022,158(2):270-276.
[11] 刘杰,孙宇鹏,李小航,等.尿路上皮癌患者外周血循环肿瘤细胞检测及其与临床特征和预后的关系[J].现代肿瘤医学,2022,30(19):3551-3555.
[12] 黎秀月,何艳,苏珍,等.外周血循环肿瘤细胞数与乳腺癌患者临床病理特征的相关性研究[J].肿瘤研究与临床,2021,33(6):414-418.
[13] SHARMA U,MEDINA-SAENZ K,MILLER P C,et al.Heterotypic clustering of circulating tumor cells and circulating cancer-associated fibroblasts facilitates breast cancer metastasis[J].Breast Cancer Res Treat,2021,189(1):63-80.
[14] HERATH S,RAZAVI BAZAZ S,MONKMAN J,et al.Circulating tumor cell clusters:Insights into tumour dissemination and metastasis[J].Expert Rev Mol Diagn,2020,20(11):1139-1147.
[15] 李金燕,吕伯乐,王文光,等.循环肿瘤细胞SE-iFISH检测结果与乳腺癌患者临床特征及预后的相关性[J].现代肿瘤医学,2022,30(6):1032-1035.
[16] DHAKA S,TRIPATHI R,DOVAL D C,et al.Role of circulating tumor cells in determining prognosis in metastatic breast cancer[J].South Asian J Cancer,2022,12(1):62-67.
[17] TEI VUGER A,ŠEPAROVI R,VAZDAR L,et al.Characteristics and prognosis of triple-negative breast cancer pa-tients:a croatian single institution retrospective cohort study[J].Acta Clin Croat,2020,59(1):97-108.
[18] COSTA R,OLIVEIRA F T R,ARAÚJO A,et al.Prognostic factors in triple-negative breast cancer:a retrospective cohort[J].Rev Assoc Med Bras(1992),2021,67(7):950-957.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录