| Objectives:The clinical features of 207 cases with malignant pleural effusion were analyzed retrospectively in this study,and the clinical significance of detection of tumor cells in malignant pleural effusion by folate receptor was discussed.Methods:The clinical data of malignant pleural effusion patients who were hospitalized in Shannxi provincial cancer hospital from January 2013 to December 2017 were analyzed retrospectively.Of the 54 patients with pleural effusion who were hospitalized in Shannxi provincial cancer hospital from January 2018 to December 2019 were selected and divided into two groups,33 confirmed to be malignant pleural effusion by exfoliative cytology examination or tissue biopsy were in the tumor group,and 21 confirmed as non-malignant tumor related diseases or benign diseases with pleural effusion were in the control group.For the two groups,peripheral blood and pleural effusion samples were collected and the levels of tumor cells were detected and compared.The ROC curves of CTCs were drawn for the two groups,so as to evaluate the potential values of CTCs in the auxiliary diagnosis of malignant pleural effusion.The survival information of 33 patients with malignant pleural effusion was followed up and recorded to statistically analyze the difference of the survival time of malignant tumor patients with different baseline CTCs,and evaluate the potential application value of this detection technology in prognosis evaluation.Results:1.Of the 207 cases with malignant pleural effusion,116(56.0%)were male,91(44.0%)were female,with maximum age at 82 years old,maximum age at 8 years old,and average age(61.16±12.55)years old,wherein 137(66.1%)cases were primary lung tumor,27(13.04%)cases were digestive system tumor,13(6.28%)cases were breast cancer,13(6.28%)cases were reproductive / urinary system tumor,5(2.42%)cases were lymphoma and 3(1.45%)cases were mediastinal primary tumor.In the 137 cases of primary lung tumor,there were 98(47.34%)cases of adenocarcinoma,16(7.73%)cases of squamous carcinoma,21(10.14%)cases of small cell carcinoma,and 1(0.48%)caseof undifferentiated carcinoma and adenosquamous carcinoma respectively.2.Statistical significance was showed between the primary causes of malignant pleural effusion and the distribution of age and gender of patents(P<0.05).The main causes of malignant pleural effusion were lung cancer(84 cases,72.50%)and digestive system tumor(20 cases,17.20%)in men,and lung cancer(53 cases,58.20%)and breast cancer(13 cases,14.30%)in women.The results of chest CT/X ray showed that pleural effusion was mainly found in the right chest(88 cases,42.5%),followed by the left chest(71 cases,34.3%)and the bilateral chest(48 cases,23.2%).3.No statistical significance was showed in gender,age,smoking history,primary cause,amount of water(large,medium,small),pleural effusion location(left,right,and both sides),pleural effusion color(blood and non-blood),pleural effusion density(clear and nepheloid),whether to receive chest perfusion therapy,the therapeutic methods of primary cause and the curative effect(P>0.05).4.Of the 33 cases with malignant tumors underwent CTCs detection,18 cases were male,15 cases were female,and the average age was(60.303±12.045).The first primary cause of malignant pleural effusion was lung cancer(17 cases)followed by breast cancer(6 cases)and lymphoma(3 cases).5.The levels of tumor cells in pleural effusion and peripheral blood were [41.30(31.4750-94.8750)] units and [12.50(7.6500-20.2750)] units respectively for the experimental group,and [5.20(3.1250-19.4000)] units and [6.40(4.4750-8.1500)] units respectively for the control group.It could be seen from the statistical analysis that the levels of tumor cells in pleural effusion and peripheral blood in the case group were significantly higher than those in the control group,and significant difference in the levels of CTCs was showed between the two groups(P<0.001).The levels of tumor cells in peripheral blood and pleural effusion were not related to the clinical characteristics(P>0.05).6.The results of ROC curve analysis showed that the cut-off value,the area under the curve(AUC),the Youden index,the sensitivity,the specificity and the accuracy of CTCs were respectively 26.50 units,0.900,0.801,0.848,0.952 and 0.889 in hydrothorax,and respectively 8.75 units,0.784,0.584,0.727,0.857 and 0.778 in peripheral blood.The detection of CTCs has a good diagnostic effect on the differentiation of benign and malignant pleural effusion.7.The median survival time of the patients with tumor cells ≥41.30 units in pleural effusionwas significantly shorter than that of the patients with tumor cells <41.30 units(9.2 months vs 18.4 months,P<0.05).The median survival time of the patients with tumor cells ≥12.50 units in peripheral blood was significantly shorter than that of the patients with tumor cells<12.50 units(8.8 months vs 19.0 months,P<0.05).The median survival time of malignant tumor patients with bloody pleural effusion was significantly shorter than that of the patients without bloody pleural effusion(9.0 months vs 18.2months,P<0.05).The median survival time of patients with lung cancer was significantly shorter than that of the patients with other types of tumors(8.0 months vs 17.2 months,P<0.05).Conclusions:1.Malignant pleural effusion usually occurs in the middle-aged and old patients(35-65 years old),and the incidence of male is higher than that of female.Lung cancer,digestive system tumor,breast cancer and reproductive/urinary system tumor are the most common primary tumors.The curative effect of pleural effusion is not related to the gender,age,smoking history,primary cause,hydrothorax amount(large,medium,and small),location(left,right,and both sides),color(blood and non-blood),turbidity(clear and nepheloid),whether to receive chest perfusion therapy,and the therapeutic methods of the primary tumor.2.The detection of the FR-positive CTCs have a relatively high diagnostic efficiency to judge whether the pleural effusionis benign or malignan.3.The higher the level of tumor cells in pleural effusion and peripheral blood,the poorer the prognosis in patients with malignant tumor.CTCs level has potential application value in judging the survival and prognosis of cancer patients. |
PDF Full Text Request