| Objectives:To study the correlation between the circulating tumor cell(CTC)epithelial-mesenchymal transition(EMT)and the clinical information of colorectal cancer.Methods:To collect the clinical data of patients with colorectal cancer and undergone surgical treatment and CTCs detected in the Gastrointestinal Surgery Department of Guangdong Provincial People’s Hospital from March 2016 to March 2017.Patients’ CTCs were detected 2 hours before surgery and 2 weeks after surgery respectively by CanpatrolTM system.CTCs were classified by EMT markers,and the correlation between the different phenotypes of CTCs and clinical data was analyzed.Results:68 patients with colorectal cancer were collected,including 39 males and 29 females;33 patients aged>60 years and 35 cases aged<60 years;14 patients with right colon cancer,23 patients with left colon cancer,and 31 cases with rectal cancer;tumor diameter less than 5cm in 44 cases,greater than or equal to 5cm in 24 cases;according to TNM clinical stage:Ⅰ in 7 cases,Ⅱ in 14 cases,Ⅲ in 35 cases,Ⅳ in 12 cases;17 cases with ≤ 3 Pieces of metastatic lymph nodes and 18 cases with>3 pieces of in stage Ⅲ.CTCs can be divided into three types:epithelial,mesenchymal,and epithelial-mesenchymal transition(EMT);The CTCs were detected in 85.29%(58/68)patients before operation,and the percentage of EMT and mesenchymal CTCs(M-CTCs)were significantly higher than that in epithelial type(45.9%vs 39.62%vs 14.48%,P<0.05).There were no significant differences in the detection rate of CTCs and its subtypes between subgroups of ≥60 years and<60 years,and the same between men and women(P>0.05);The mean of CTCs(11.64 vs 8.61 vs 5.29),EMT-CTCs(5.64 VS 2.91 VS 2.0)and M-CTCs(5.36 VS 3.65 VS 2.65)in patients with right colon cancer were higher than those in left colon cancer and rectal cancer patients,the difference was statistically significant(P<0.05),but there was no significant difference in the detection of epithelial CTCs(E-CTCs)between the three groups(P>0.05);The difference of CTC detection rate(84.09%vs 87.50%)between the two groups with the largest tumor diameter less than 5 cm and greater than or equal to 5 cm was not statistically significant(P>0.05);The mean CTCs(10.33 VS 6.30),EMT-CTCs(4.29 VS 2.39)and M-CTCs(5.29 VS 2.59)of the group with the largest diameter ≥5 cm were slightly higher than those less than 5cm.The E-CTCs of the group with the largest diameter ≥5 cm was slightly lower than those of patients less than 5cm(0.795 VS 1.32),but there was no significant difference between the above two groups(P>0.05);The CTC detection rate(71.43%VS 78.57%VS 85.71%VS 100%),the overall average CTCs(20.42 VS 4.14 VS 4.43 VS 5.40),EMT-CTCs(7.67 VS 1.71 VS 2.36 VS 2.03)and M-CTCs(8.5 VS 2.43 vs 1.71 VS 2.80)in stageⅣ were higher than those in stage Ⅰ,Ⅱ and Ⅲ patients(P<0.05).The epithelial CTCs in patients with stage IV were also higher than those in the other three groups,but the difference was not statistically significant(P>0.05).There was no significant difference between Ⅰ,Ⅱ and Ⅲ(P>0.05),CTCs in stage Ⅰ and Ⅱ patients without lymph node and distant metastasis were compared,the detection rates of CTC(71.43%VS 78.57%)and the mean CTC(4.14 VS 4.43)in stage Ⅰ were slightly lower than those in stage Ⅱ patients,but the difference was not statistically significant(P>0.05).The overall average CTCs of the high-risk patients(6,25 VS 3.7)was significantly higher than that of the low-risk patients(P<0.05).The mean values of EMT-CTCs(3.75 VS 1.8)and M-CTCs(2.25 VS 1.5)in high-risk group were higher than those in low risk group,but the difference was not statistically significant(P>0.05).The average value of E-CTCs(0.25 vs 0.40)in high-risk group was lower than that of the low-risk group,but the difference was also not statistically significant(P>0.05).The overall average CTCs(6.72 VS 4.0),the mean E-CTCs(0.72 VS 0.41),EMT-CTCs(2.17 VS 1.88)and M-CTCs(3.68 VS 1.71)in the patients with>3 metastatic lymph nodes were higher than those of patients with ≤3 metastatic lymph nodes,but there was only the difference of M-CTCs of statistical significance(P<0.05).The CTC detection rate and the value of all CTC subtypes was significantly lower after the operation in those patients with stage Ⅰ,Ⅱ and Ⅲ except stage Ⅳ.The correlation analysis showed that the total number of CTCs and M-CTCs were correlated with TNM clinical stage(P=0.026 and 0.042,respectively).The later the tumor staging,the more the total number of CTCs and M-CTCs,while there was no significant correlation was observed between the E-CTCs and clinical stage.The total number of CTCs,epithelial type,and mesenchymal type were positively correlated with CEA values(P = 0.016,0.010,0.013,respectively).There was no significant correlation between Cal 9-9 and tumor maximal diameter.Only the number of mesenchymal CTCs and EMT-CTCs were positively correlated with lymph node metastasis(P<0.05).Conclusion:Circulating tumor cells(especially mesenchymal CTCs)is closely related to the clinical stage,tumor location,risk factors and metastasis.The epithelial-mesenchymal transition of CTC plays an important role in the metastasis of colorectal cancer. |
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