The Significance Of Circulating Tumor Cells In The Diagnosis,Treatment Response Monitoring And Prognosis In Ovarian Cancer

Objective: To detect the levels of circulating tumor cells in peripheral blood of patients with benign ovarian tumors and ovarian cancer,and to evaluate the value of circulating tumor cells in the diagnosis,efficacy monitoring and prognosis in ovarian cancer.Methods: From December 2016 to June 2019,60 patients who diagnosised with adnexa mass were selected from the department of Sheng Jing Hospital,China Medical University.5ml venous blood was taken before surgery or neoadjuvant chemotherapy,and CTCs were detected by immunomagnetic bead negative enrichment combined with in situ hybrid immunofluorescence.The numbers of CTCs,CA125,HE4,and CA724 were compared between the two groups,and the sensitivity,specificity,and positive were calculated.The predicted value,negative predicted value,and the area under the ROC curve were statistically analyzed to draw the ROC curve;the relationship between CTCs and clinicopathological characteristics was analyzed.Blood samples were taken from patients before and after chemotherapy,and the relationship between CTCs changes and clinical biological markers and imaging was observed.The efficacy and prognosis of CTCs and ovarian cancer were analyzed.Results: 1.The detection of CTCs in the ovarian patients(88.89%)were higher than the benign ovarian tumor group(6.67%).2.The numbers of CTCs,CA125,HE4 and CA724 in patients with ovarian cancer group were higher than those in benign ovarian tumor group,the difference was statistically significant(P <0.05).3.The areas under the ROC curve of CTCs,HE4,CA125,CA724 were 0.92,0.908,0.81,0.725,respectively.In the early(stage I-II)diagnosis of ovarian cancer,the sensitivity of each index is CA125>CTC> HE4 = CA724(88.89%> 55.56%> 44.44% = 44.44%),and the specificity is CTCs= HE4> CA724> CA125(93.34% = 93.34% = 93.34%> 33.34%).CTCs have certain diagnosis value in ovarian cancer.4.The positive rate of CTCs is related to high FIGO stage,high pathological stage,pathological type(serous),and exsist ascites.The difference is statistically significant(P <0.05).It is not related to age,N stage,M stage and tumor cyst or solid traits(P> 0.05).5.The detection rates of CTCs in stage I,II,III and IV of ovarian cancer were 25%(1/4),80%(4/5),96.55%(28/29),and 100%(7/7).The detection rate of CTCs higher when the FIGO stage higer(P <0.05).6.Patients with disease progression(PD)group had higher CTCs before treatment than those with disease remission or stable disease(PR + SD)group,and the difference was statistically significant(P <0.05).7.The change in CTCs count before treatment and after two cycles of chemotherapy has nothing to do with tumor efficacy,P> 0.05.8.The number of CTCs varies with the efficacy of treatment,and takes precedence over the serological markers CA125 and HE4.9.CTCs positive were not related to overall survival Period(OS)(P =0.133> 0.05),but was related to disease-free progression(PFS)(P = 0.044 <0.05).10.Univariate analysis of PFS and OS showed that CTCs,age,tumor size,FIGO staging,T stage,N stage,M stage,unilateral,tumor cyst or solid traits,CA125,CA724,HE4,pathological classification and with or without ascites were not related to OS and PFS.Neither can predict OS and PFS in patients with ovarian cancer(P> 0.05).Conclusions: 1.The detection rate of CTCs in patients with ovarian cancer is higher than that in benign ovarian tumors.CTCs can be an ideal biomarker for the diagnosis of ovarian cancer than CA724,but limited in diagnosising earlier ovarian cancer.2.The positive rate of CTCs is related to high FIGO stage,high T stage,pathological classification(serous)and exsist ascites,but not to age,N stage,M stage,tumor cyst or solid traits.The higher the FIGO stage,the higher the detection rate of CTCs.3.The change in the number of CTCs can reflect the therapeutic effect of patients with ovarian cancer,and the CTCs count before treatment in patients with disease progression(PD)group is higher than that in patients with disease remission or stable disease(PR + SD)group.4.CTCs were related to ovarian cancer patients' progression-free survival(PFS),but not related to overall survival(OS).CTCs cannot be used as independent predictor to predict patients' PFS and OS.