Correlation Between Peripheral Blood Circulation Tumor Cells And Chemotherapy Efficacy And Prognosis In Patients With Advanced Lung Cancer

ObjectiveAt present,lung cancer has become one of the most common cancers with morbidity and mortality in the world,which has greatly threatened people's life and health.For lung cancer,comprehensive treatment models are currently used in clinical practice,including surgery,radiotherapy,chemotherapy,targeted therapy,and biological immunotherapy.Although the survival of lung cancer patients has been improved under various treatments,the prognosis of most patients is still poor.The main cause of poor prognosis and high mortality in cancer patients is recurrence and metastasis.Our ability to assess invasive diseases such as lung cancer currently depends primarily on imaging techniques such as plain film photography,computed tomography,radionuclide bone scan,magnetic resonance imaging,and positron emission tomography.These imaging studies can tell us where,size,and number of diseases,but they are unable to determine whether tumor cells enter the peripheral blood that may be related to whether the tumor cells are transferred through blood to previously unrecognized areas.How to intuitively and accurately understand the trend of tumor metastasis is crucial for the treatment of tumors.Studies have shown that the appearance of circulating tumor cells(CTCs)in the blood is a prerequisite for distant metastasis and a key link in the formation of metastases.In recent years,the application value of CTCs in tumor diagnosis,efficacy evaluation,prognosis evaluation and individualized treatment has become a hot topic in clinical research.This study examined the number of peripheral blood circulating tumor cells(CTCs)in patients with advanced lung cancer before and after chemotherapy,and analyzed the relationship between the number of CTCs and clinical features,chemotherapy efficacy,progression-free survival,and further explored the relationship between the circulating tumor microemboli(CTM)and prognosis.MethodsA total of 58 patients with advanced primary lung cancer diagnosed by pathology were enrolled in the First Affiliated Hospital of Zhengzhou University from February 2017 to December 2018,52 of whom received platinum-containing dual-drug regimen.The number of peripheral blood CTCs in patients with advanced lung cancer before 1 day of chemotherapy and 2 cycles of chemotherapy was detected and recorded by the modified ISET(CTC-Biopsy system).52 patients with lung cancer who underwent chemotherapy underwent imaging examination every 2 cycles and assessed clinical outcomes.The data was processed by SPSS21.0 statistical software.The?~2 test was used to compare the count data groups;the Spearman rank correlation method was applied to the correlation analysis of the ordered multi-class variables in the two groups;Survival analysis was performed using the Kaplan-Meier method,and the survival curve was compared using the Log-Rank test.The difference was considered statistically significant when P<0.05.Result1.The positive rate of CTCs in lung cancer patients with stage TNM stage(87.5%)was significantly higher than that in stage III patients(38.5%).The difference was statistically significant(P=0.000);the positive rate of CTCs and the gender of lung cancer patients,Age,smoking history,and histological type were all unrelated(P>0.05).2.The positive rate of CTCs after chemotherapy(61.5%)was lower than that before chemotherapy(65.4%),and the difference was not statistically significant(P=0.804).3.5 patients with advanced lung cancer underwent CT examination after 2 cycles of chemotherapy,including 17 cases of PR,25 cases of SD and 10 cases of PD.The number of CTCs after chemotherapy was 16 cases higher than that before chemotherapy,unchanged in 5 cases and decreased in 31 cases.According to the relevant analysis,the number of CTCs was negatively correlated with the efficacy of chemotherapy(r=-0.397,P=0.004).4.The median PFS of patients with positive CTCs before chemotherapy was 105days(95%CI,94.96-115.04 days),and the median PFS of CTCs negative group was196 days(95%CI,110.71-281.29 days),Log Rank test The difference between the two was statistically significant(?~2=8.421,P=0.004).5.The median PFS of CTCs positive for lung cancer patients after chemotherapy was 102 days(95%CI,82.53-121.47 days),and the median PFS of CTCs negative group was 160 days(95%CI,61.36-258.64 days),Log Rank test The difference between the two was statistically significant(?~2=7.319,P=0.007).6.The median PFS of patients with lung cancer who had increased CTCs after chemotherapy was 70 days(95%CI,31.54-108.46 days),while the median PFS of patients with reduced or unchanged CTCs after chemotherapy was 126 days(95%CI,77.60-At 174.39 days),the Log Rank test showed no significant difference between the two(?~2=2.862,P=0.091).7.Ten patients with CTM were detected in 52 patients with advanced lung cancer.The median PFS was 99 days(95%CI,69.54-128.46 days)in patients with CTM,and the median PFS was 119 days in patients without CTM.(95%CI,71.10-166.91 days),Log Rank test showed that the difference was statistically significant(?~2=5.654,P=0.017).Conclusion1.The positive rate of CTCs is closely related to the stage of lung cancer.2.Chemotherapy efficacy in patients with advanced lung cancer may be predicted by observing changes in the number of CTCs before and after chemotherapy.3.Positive CTCs before or after chemotherapy may be a prognostic factor.4.CTM may have an adverse effect on the prognosis of patients with advanced lung cancer.