The Ralationship Between Circulating Tumor Cells And The Clinico-pathologic Characteristics In Patiants With ?A, ?B, And ? Stage Non-small Cell Lung Cancer

Objective Validate the positive rates of CTCs detected by Cell Search in patiants with stage IIIA, IIIB and IV non-small cell lung cancer, and explore the relationship between CTCs and the clinicopathologic characteristics, such as age, sex, weight change, smoking, stage, distant metastasis, histological type, degree of differentiation, serum tumor markers, E-cadherine and LDH, to verify the feasibility of CTCs as a parameter in evaluating the severity and prognosis of NSCLC.Methods Blood samples were taken from patients with stage IIIA, IIIB and IV NSCLC proven by pathology from Hunan Province Tumor Hospital before therapy. CTCs in collected blood samples were detectd by Cell Search. E-cadherine expression in paraffin embedded sections of collected patients were detected by immunohistochemical SP method. The number of CTCs were divided into three degrees: CTCs=0,CTCs=1, CTCs?2. The relationship between CTCs and the clinicopathologic factors was analyzed by using SPSS21.0, in which Spearman correlation test chi-square test were used for univariate analysis and ordinal logistic regression was used for multi-factor analysis.Results 1 Detection of CTCs:Of total 118 cases, 71 cases(60.2%) had no CTC, and 47 cases(39.83%) had one or more CTCs, in which 24 cases(20.33%) had one CTC, and 23 cases(19.49%) had two or more CTCs. The maximum of CTCs count was 74, and the average was 2.67. When cutoff value was 1,according to the pathological stage,the detected ratio of IIIA stage,IIIB stage,IVstage positive rates was 30.00%,21.74%,46.43% respectively. When cutoff value was 2,according to the pathological stage,the detected ratio of IIIA stage,IIIB stage, IV stage positive rates was 0%, 4.35%, 26.19% respectively.2 The expresion of E-cadherine in lung cancer tissu and the relationship with the degee of the number of CTCs:Of total 53 cases, 2 cases(3.77%) were negative for E-cadherine, 4 cases(7.55%) were weankly positive, 7 cases(13.21%) were positive, and 40 cases(75.47%) were strongly positive. When negative and weak expression was defined as lower expression,the number of lower expression cases was 6(11.32%). By using Spearman correlation test, the expression degree of E-cadherine and the number of CTCs showed no obvious correlation.3 The relationship between the degree of CTCs count and the clinical and pathological features : By using Spearman correlation test, the degree of CTCs count showed no obvious correlation with age,CEA,CA125,LDH,PS score and differentiation degree(P<0.05), but showed obvious correlation with TNM stage, N stage, and the number of disatant metastases, showing positive correlation with previous three. By using chi-square test,CTCs showed no obvious correlation with weight change, brain metastasis, liver metastasis, bone metastasis, adrenal metastasis, contralateral lung metastasis, pericardium metastasis, pleura metastasis, axillary lymph nodes metastasis and histological type, but showed obvious correlation with sex, smoking and retroperitoneal lymph nodes metastasis(P<0.05). By using ordinal logistic regression, the state of retroperitoneal lymph nodes metastasis, showed significant correlation with the number of CTCs(P=0.032), The OR value of no retroperitoneal lymph node metastasis group was 0.122 with retroperitoneal lymph node metastasis group as the reference category.Conclusions 1 The sensibility of detecting CTCs in patiants with stage IIIA-IV NSCLC by Cell Search was 39.83%, and the sensibility in patiants with distant metastasis was 46.43%.2 There no significant correlation between the degree of expression of E-cadherine and the degree of CTCs count detected by Cell Search in stage IIIA-IV non-small cell lung cancer.3 Among age, sex, weight change, smoking, TNM stage, the number of distant metastasis, histological type, differentiation, serum tumor markers, E-cadherine and LDH, the state of retroperitoneal lymph nodes metastasis was a independent influencing factor for the number of CTCs, therefore, detecting CTCs may be able to be a usefull means of monitoring retroperitoneal lymph nodes metastasis.