Preliminary Study On The Chemotherapy Curative Effect And Prognosis Judgement Of Circulating Tumor Cells In Patients With Advanced Non Small Cell Lung Cancer

Objective:In this study, we dynamically monitor the amount of circulating tumor cells(CTCs) in advanced non small cell lung cancer patients before chemotherapy, after 2 cycles and imaging assessment for disease progression.focuing on the analysis and in the near future curative effect and prognosis of cancer, further to explore the value of its clinical application.And analysis of the impact of multiple factors on the prognosis of patients, whether CTCs can be used as a independent factor to determine the prognosis of patients.Methods:We detected the expression level of CTCs in 118 NSCLC patients before chemotherapy and found 107 eligible cases. After 2 cycles of chemotherapy,78 of them were evaluated by imageological examination results and extracted 7.5ml peripheral blood for CTCs testing. Among those 78 patients,there were 42 showed disease progressions during our follow-up visits.We extracted the preipheral blood 42 patients again for CTCs testing after these progressions.There is no astandard about the cut-off value of positive CTC in NSCLC patients by now.Therefore,in ths study,we made the cut-off value as 1,which means the results of CTCs testing would be positive as long as we found any CTCs in 7.5ml peripheral blood.Results:1.Correlation between CTCs and prognosis:We detected the CTCs of 107 cases before chemotherapy, and the positive rate of CTCs was 39.3%;The median PFS of positive patients was 4.3 months, while the negative patients was 7.3 months, the statistical difference of the data was significant(P = 0.002); 78 of those patients were detected CTCs after 2 cycles of chemotherapy, the median PFS of positive group was 2.5 months, but that for negative patients was 5.8 months, the difference between the two groups was statistically significant(P = 0.002); But the level of CTCs change and the level of PFS in patients was not statistically significant before and after chemotherapy.2.The correlation between CTCs and the long-term survival of patients: the 1 year survival rate of CTCs positive patients was 35.7% before chemotherapy, but the negative 60.0%; the difference of them was statistically significant(P=0.014).After 2 cycles of chemotherapy, the 1 year survival rate of CTCs positive patients was 30%, while the negative was 56.8%; the difference was statistically significant(P=0.038).The change of CTCs level before and after chemotherapy has not relation to 1 year survival rate;There was no significant difference in the level of CTCs and the 1 year survival rate of disease progression.3.The relevance between CTCs change and radiographic assessment before and after chemotherapy:There are 78 patients before chemotherapy and 2 cycles of chemotherapy after imaging evaluation, and blood line CTCs detection, CTCs positive rate was 41.0% before chemotherapy, after chemotherapy was 25.6%, the change of CTCs was statistically difference before and after chemotherapy.According to RECIST criteria, 25 patients achive PR, 37 patients for SD, 16 patients were evaluated for PD, without CR. CTCs increased in 17 patients before and after chemotherapy, decline in 21 cases, 40 cases data statistics show that there was no change in the near future curative effect evaluation between CTCs level changes and imaging evaluation,The result was high consistency(P<0.05).In CTCs positive rate, according to the hierarchical imaging evaluation showed that PD patients, CTCs positive rate was 68.8%, and radiographic evaluation of patients with SD, CTCs positive rate was 18.4%, imaging evaluation for patients with PR, its CTCs positive rate was only 8.2%, and the data was statistically difference(P< 0.05).4.The relationship between CTCs level and recurrence of disease progression: in the image assessment for 42 patients was disease progression, 33 cases of them after 2 cycles of chemotherapy and imaging assessed SD and PR,the rate of CTCs positive patients was 30.3%When image assessing disease progression,the rate of CTCs positive occupied 66.7% ratio, the data was statistically significant difference(P = 0.003). 28 CTCs positive patients of PD patients, distant metastasis recurrence rate was 71.4%;while 14 cases were negative,distant metastasis and the recurrence rate was 35.7%, the data were statistically significant difference(P = 0.026).5. Patients with TNM stage and PFS correlation, the patient’s age and smoking history were correlated with the 1 year survival rate. Conclusion:1.Expression level of CTCs before and after 2 cycles of chemotherapy is predictors factors of PFS;2.Expression level of CTCs before chemotherapy is predictors factor of 1 year survival rate;3.The variations of CTCs before and after chemotherapy show uniformity with imaging assessment results for chemotherapeutic effect..