Clinical Research On Detection Of Circulating Tumor Cells In Peripheral Blood Of Primary Liver Carcinoma

Objective：To evaluate the clinical value of detecting circulating tumorcells in primary liver carcinoma.Methods：In the present study,twice5mL of peripheral blood samples from60patients of primary liver carcinoma were tested prior to resection andthereafter,and who were underwent hepatectomy in Hepatobiliary Surgery ofSichuan Cancer Hospital during May2013to January2014.We analyzed thepositive cases and the enumeration of CTC detection before and after surgery byusing CanPatrolTMto detect circulating tumor cells of peripheral blood,and atthe same time followed up their recent survival status.Results：①The positive rate and the enumeration of CTCs:26patientsfrom preoperative peripheral blood of60patients of primary liver carcinomawere detected CTC,and the positive rate was43.3%(26/60) and the number ofCTCs was5.2±7.0(1～31).②Compared CTC between before and after surgery: 39patients from postoperative peripheral blood of60patients of primary livercarcinoma were detected CTC,and the positive rate was65.0%(26/60),werehigher than preoperative positive rate43.3%(26/60)(P<0.05). The postoperativenumber of CTCs was6.0±6.0(1～28),which were more than the preoperativenumber of CTCs which was5.2±7.0(1～31)(P<0.05).③Compareinstallments:14early stage patients of primary liver carcinoma involved,whichhad2preoperative CTC-positive patients(14.3%),its number of CTCs was2.0±1.4(1～3), and3postoperative CTC-positive patients(21.4%),its number ofCTCs was2.0±1.0(1～3);CTC may be detected from both preoperative andpostoperative peripheral blood of early stage of primary liver carcinoma,but thecomparison of positive rate and the enumeration of CTCs be between before andafter surgery both were no significance(P>0.05).46intermediate stage patients ofprimary liver carcinoma involved,which had24preoperative CTC-positivepatients(52.2%),its number of CTCs was5.4±7.3(1～31), and36postoperativeCTC-positive patients(78.3%),its number of CTCs was6.3±6.2(1～28); Boththe CTC-positive rate and the enumeration of CTCs in postoperative was higherthan in preoperative peripheral blood of intermediate stage patients(P<0.05).Both the preoperative and postoperative CTC-positive rate and theenumeration of CTCs of intermediate stage patients were higher than the earlystage patients(P<0.05).④Abnormal counting discrete distribution:9patientswhose enumeration was discrete value in preoperative or postoperativeblood,among them3patients occured recurrence.⑤Recent follow-up:the follow-up time of14early stage patients ranged from3.5to9months,and all ofthem were disease free survival.The follow-up time of46intermediate stagepatients ranged from2.5to9.5months,but6of them appeared recurrence ormetastasis after surgery,3cases occured recurrence or metastasis after2month,and other3cases were appeared1,3,4months respectively.9cases ofabnormal counting discrete distribution in preoperative or postoperative blood,3of them occured recurrence and distant metastasis in early time,and6of themwere accepted treatment combined with DDS or targeted therapy afterhepatectomy.Conclusion：①CanPatrolTMcan detect CTC from the peripheral blood inprimary liver carcinoma effectively.②CTC may be detected from bothpreoperative and postoperative peripheral blood of early stage of primary livercarcinoma,there maybe existed early micrometastasis.③Both the preoperativeand postoperative CTC-positive rate and enumeration in the intermediate stagepatients were significantly higher than those early stage patients,which suggestus that CTC was obviously correlated with tumor stage.④Both the postoperativeCTC-positive rate and enumeration of intermediate stage patients weresignificantly higher than that of preoperative peripheral blood,which infer usthat it may be existed haematogenous spread of liver cancer cells when theintermediate stage patients were underwent hepatectomy,but if surgeondiminished the extrusion of tumor during an operation,or strengthen theimmuno-regulation therapy during perioperative period,it would be reduced.⑤ We can get some hints from the result analysis of detecting circulating tumorcells and clinical case that it will help reduce recurrence and metastasis bytreated with comprehensive treatment in time after hepatectomy,such asDDS,and patient with the preoperative or postoperative abnormal CTC risingcould be the another high risk factor of recurrence or metastasis aftersurgery,which should be combined with systemic targeted therapy as early aspossible.