【摘要】 目的探讨胃癌术中腹腔游离癌细胞(FCC)检测的最佳阳性判定值,以及腹腔FCC的存在对预后的影响。方法用实时荧光RT-PCR方法检测术中腹腔FCC,并进行5年的随访。用MedCalc软件分析FCC最佳阳性判定值;[大于此值表示FCC存在,标记为FCC(+)],并前瞻性地分析FCC(+)组及(-)组与预后的关系。最后用多因素Cox回归模型分析影响预后的独立因素。结果(1)最佳阳性判定值为31.21拷贝/mL时约登指数最高;(2)FCC(+)与(-)组的平均存活期分别为17.2个月和48.7个月,中位存活期分别为8.1个月和60.0个月;5年累积存活率分别为9.1%和67.4%。Kaplan-Meier生存分析显示,FCC(-)组生存时间明显长于FCC(+)组(P=0.000)。Cox模型分析发现FCC,浆膜及远处转移是影响生存预后的独立因素(P<0.05)。结论(1)FCC最佳阳性判定值为31.21拷贝/mL;(2)腹腔FCC是影响预后的独立危险因素之一,FCC(+)反映手术时肿瘤存在扩散状态,预示患者预后较差。更多还原

【Abstract】 Objective To determine the optimal cut-off value of carcinoembryonic antigen (CEA) mRNA level for detection of free cancer cells (FCC) in peritoneal washes with real-time PCR and its clinical significance. Methods The CEA mRNA levels in peritoneal washes from 65 cases of gastric cancer were detected by real-time RT-PCR. After 5-year follow-up,cut-off value of CEA mRNA level was obtained with the ROC curve analysis and the relationship between FCC and prognosis with Kaplan-Meier method was studied.Results (1)With the ROC curve analysis,if the cut-off value of CEA mRNA level was31.21,the Youden’s index was the highest.(2)The mean survival time (months) in group of FCC(+),(-)was 17.2 and 48.7 months respectively,The median survival was 8.1 and 60.0 months,respectively,with significant difference (P= 0.000).The 5-year survival rate was 9.1% and67.4%,respectively. Compared with FCC(+) group,the FCC(-) group had significantly extended life span. COX regression showed that FCC was an independent prognostic factor.Conclusions (1) Our results suggest that the best cut-off value of CEA mRNA levels for detection of FCC in peritoneal washes is 31.2 copies/mL;(2) This study shows that FCC is an independent factor that affects prognosis. FCC(+) denotes the presence of intraoperative tumor dissemination and predicts a poor prognosis.更多还原