The Study Of Circulating Tumor Cells In The Diagnosis Of Early Breast Cancer And Their Changes Before And After The Surgery

Objective:In order to explore the clinical significance of CTC in early breast cancer(EBC)patients and to assess the risk of hematogenous micrometastasis during surgery,we analyzed the correlation between CTC and clinical pathological features,diagnostic performances of individual and combined detection of routine tumor markers and changes before and after the surgery,by CTC positive rate and expression level of CTC in patients with EBC.Methods:63 patients with early breast cancer who were admitted to the Department of oncology of Chengde Central Hospital from December 2014 to December 2016 were collected.46 patients with benign breast disease were selected from the Department of oncology of Chengde Central Hospital in the same period as the benign breast disease group,and 38 healthy individuals were selected from the health examination center of Chengde Central Hospital as the healthy group.CTC and CEA,CA15-3 and CA125 were detected in the breast cancer group on 1 to 3 days before operation,and at the same time,the above four indexes were also detected in benign breast disease group and healthy group.Blood samples were collected for CTC detection in the breast cancer group at 3 time points(3-4 days,7-8 days and a month after the surgery).The level of CTC in breast cancer group,benign breast disease group and healthy group was detected by the folate receptor cell test kit.The three tumor markers were detected by electrochemiluminescence immunoassay(Cobas6000)with Swiss Roche.The database was established by Excel software,and SPSS19.0 software was used for statistical analysis.For the measurement data,the normal distribution test was first carried out,and the data of the normal distribution was represented by the mean ± standard deviation.The comparison between the groups was based on the single factor analysis of variance(one-way ANOVA).The multiple comparisons of variance homogeneous were based on LSD method,method,in which the difference was statistically significant when p <0.05.The enumeration data were expressed in the form of the percentage,and the chi square test was used to compare the single factor group.The difference was statistically significant when p <0.05.Results:1 CTC were detected in 63 patients with early breast cancer,and the positive rate of the patients was 41.27%.There was no significant correlation between CTC status and clinical pathological characteristics in patients with early breast cancer.2 The expression levels of CTC,CEA,CA15-3 and CA125:Detection results of CTC in breast cancer group,benign breast disease group and healthy group were as below.The level of CTC was 8.86±1.33 FU/3ml in breast cancer group,3.20 ± 0.87 FU/3ml in benign breast disease group and 2.99±0.94 FU/3ml in healthy group.The level of CTC in breast cancer group was significantly higher than that in benign breast disease group,and the difference was statistically significant(p <0.05).The level of CTC in breast cancer group was significantly higher than that in healthy group,and the difference was statistically significant(p <0.05).There was no significant difference of CTC level between benign breast disease group and healthy group(p >0.05).Detection results of CEA,CA15-3 and CA125 in breast cancer group,benign breast disease group and healthy group were as below.In breast cancer group,the level of CEA,CA15-3 and CA125 was 7.6±3.5 ng/ml,37.2±17.9 U/ml and 43.9±20.6 U/ml respectively.In benign breast disease group,the level of CEA,CA15-3 and CA125 was 3.7 ± 1.6 ng/ml,15.4 ± 6.8 U/ml and 24.7±9.2 U/ml respectively.In healthy group,the level of CEA,CA15-3 and CA125 was 2.5±1.1 ng/ml,14.8±5.3 U/ml and 20.2±4.7 U/ml respectively.The levels of CEA,CA15-3 and CA125 in breast cancer group were higher than those in benign breast disease group,the difference was statistically significant(p <0.05).The levels of CEA,CA15-3 and CA125 in breast cancer group were higher than those in healthy group,the difference was statistically significant(p <0.05).The levels of CEA,CA15-3 and CA125 in benign breast disease group were not significantly different from those in healthy group(p >0.05).3 The results of evaluation of single detection and joint detection of CTC and CEA,CA153 and CA125 in the diagnosis of early breast cancer is following.In the single detection,the sensitivity(41.26%),specificity(97.82%)and accuracy(66.35%)of CTC were the highest.While the sensitivity(31.74%),specificity(97.82%)and accuracy(60.74%)of CA15-3 were highest among tumor markers.The sensitivity(53.96%)and accuracy(71.02%)of the combined detection of CEA,CA15-3 and CA125 were significantly higher than those of the four single detection,but the specificity(91.30%)was a little lower than that of CEA(93.47),which was the lowest specificity one in the single detection.As to CTC combined with CEA,CA15-3 and CA125 for 4 joint detection,the sensitivity(66.66%),specificity(93.47%)and accuracy(79.43%)were all significantly higher than those in the combination of 3 tumor markers.The difference was statistically significant(p <0.05).4 The results of CTC changes before and after the surgery is as below.Paired chi square test was used to analyze the changes of CTC positive rate in 63 patients with EBC before and after operations.The CTC positive rate of 3 to 4 days after surgery(53.97%)was significantly higher than that(41.27%)before operation,but the difference was not statistically significant(p >0.05).Compared with the preoperative rate of CTC,the CTC positive rate of 7 to 8 days after surgery(38.09%)was a little lower,but the difference was not statistically significant(p >0.05).Compared with the preoperative rate of CTC,the CTC positive rate of a month after surgery(44.44%)was a little higher,but the difference was not statistically significant(p >0.05).The level of CTC expression in 63 patients with EBC before and after operation was analyzed by univariate analysis of variance and LSD.The average level of CTC was 8.86±1.33 FU/3ml before operation,and the level increased to 120.14±10.20 FU/3ml,compared with preoperative difference was statistically significant(p <0.05).The level of CTC decreased to 41.41 ± 4.80 FU/3ml at 7-8 days after operation,the difference was statistically significant(p <0.05).The level of CTC decreased to 8.51±1.38 FU/3ml at one month after operation,which was not statistically significant(p >0.05).Conclusion:1 There was no significant correlation between CTC level and clinical pathological features of early breast cancer patients,such as menstrual status,regional lymph nodes,tumor stage,hormone receptor status and HER-2 status.So the current clinical pathological parameters could not predict the CTC level,suggesting that CTC may be an independent prognostic factor for breast cancer.2 The level of CTC in patients with early breast cancer was significantly higher than that in patients with benign breast disease and healthy people.The sensitivity,specificity and accuracy of the combination of CTC,CEA,CA15-3 and CA125 were increased,compared with the combined detection of three tumor markers,which may help to improve the early diagnostic rate of breast cancer and preoperative diagnosis.3 The positive rate of CTC was dramatically increased in a short time after operation,and it decreased significantly in a month.For a little longer time,surgery may not increase the risk of tumor micrometastasis.