Relationship Of Circulating Tumor Cells With Clinicopathological Characteristics And Prognosis In Gastric Cancer Patients

Objective: Through the study on the detection level of peripheral blood circulating tumor cells(CTCs)in gastric cancer patients,and compared with detection level of CTCs,peripheral blood tumor markers and the related data from with benign gastric lesions who visit in same period.To investigate the correlation between the detection level of CTCs and clinicopathological features in gastric cancer patients,and the relationship between the detection level of different CTCs and prognosis.Methods: This study used negative enrichment combined with immunofluorescence in situ hybridization(im FISH)to detect CTCs.From August 2015 to December 2016,100 patients with gastric cancer who had undergone general surgery in hospitals were selected as gastric cancer patients,and 38 patients with benign stomach diseases were included in the control group during the same time.The detection levels of CTCs,CEA,CA-125,CA-199,TNM staging,tissue ki-67 expression,tumor differentiation,and vascular tumor embolus were compared between the two groups.SPSS 21.0 statistical software was used for analysis.The measurement data were analyzed by t test.The data of each group were compared using χ2 test or Fisher’s exact test.P<0.05 was considered statistically significant.Results:(1)The detection rate of CTCs was 94% in gastric cancer patients and 28.9% in control patients(P < 0.05).When the optimal cutoff value was 2 cells/3.2ml blood(AUC=0.935;95% CI: 0.894-0.976;P<0.001),the sensitivity and specificity of CTCs for detecting gastric cancer were 89% and 89.5% respectively.The diagnostic predictive value of CTCs is significantly better than CEA,CA-125,and CA-199.(2)The positive rate of CTCs in gastric cancer group(≥2/3.2 ml)was significantly correlated with the depth tumor invasion,lymph node metastasis and TNM staging of patients(P < 0.05).However,the detection level of CTCs was not correlated with the patient’s gender,age,tumor location,tumor differentiation,and vascular tumor embolus(P>0.05).(3)The disease-free survival of CTCs-negative group in gastric cancer group(<2/3.2ml)was significantly longer than that of high expression of CTCs(P < 0.05);The risk of recurrence after surgery in the CTCs negative group was significantly lower than that in the CTCs negative group(P < 0.05).Conclusions:(1)Negative-enrichment combined with immunohistochemistry has high sensitivity and specificity in the detection of CTCs in gastric cancer patients.It can be used as a hematological marker for the diagnosis of gastric cancer,and improve the early diagnosis rate of gastric cancer.(2)The detection level of CTCs in gastric cancer patients was significantly correlated with the depth tumor invasion,lymph node metastasis and TNM staging.However,it was not related to sex,age,tumor location,tumor differentiation,and vascular tumor embolus.(3)Patients with positive preoperative CTCs have significantly shorter postoperative diseasefree survival time than those with negative ones,and the risk of postoperative recurrence is significantly higher.Preoperative detection of CTCs is helpful for the judgment of prognosis of gastric cancer patients,and has certain guiding significance for clinical work.