The Value Of Circulating Tumor Cell In The Colorectal Cancer

Objective: To investigate the relationship between CTC and clinicopathological features in patients with colorectal cancer(CRC),and to explore the value of CTC in diagnosis and prognosis evaluation of CRC.Methods: The peripheral blood of patients with colorectal cancer from September 1,2019 to April 7,2020 in our hospital was collected.Through the inclusion criteria and exclusion criteria,the eligible cases were screened out.The negative enrichment combined with immuno-fluorescence in situ hybridization was used,The clinical and pathological data of each case(such as sex,age,tumor size,tumor site,differentiation degree,invasion depth,lymph node metastasis,distant metastasis,TNM stage,vessel invasion,nerve invasion,CEA,CA19-9,etc.)were consulted in detail,and followed up the patient's progress.?2 test,t test,ROC curve,survival analysis and other statistical methods were used for statistical analysis.Results: 1.112 cases of colorectal cancer were included in the experimental group,the positive rate of CTC was 82.14%(92/112),the count of CTC was 3.20±2.28.In the control group,the positive rate of CTC was 0,the count was 0.The positive rate of CTC and the count of CTC in colorectal cancer were significantly higher than those in benign colorectal disease and healthy subjects(P=0.000,P=0.000).2.The positive rate of CTC was 88.57%(62/70)and the count of CTC was 3.37±2.08 in male patients,the positive rate of CTC was 71.43%(30/42)and the count of CTC was 2.90±2.58 in female patients.The positive rate of CTC in male patients was higher than that in female patients,the difference was statistically significant(P=0.022),there was no significant difference of count between male and female patients(P=0.297).The positive rate of CTC was 84.15%(69/82)and the count of CTC was 3.06±1.89 in middle differentiation,the positive rate of CTC was 76.67%(23/30)and the count of CTC was 4.10±3.21,the positive rate of CTC in middle differentiation was higher than that in low differentiation,the difference was notstatistically significant(P=0.360);the count of CTC in low differentiation was higher than that in middle differentiation,the difference was statistically significant(P=0.038).The positive rate of CTC was 28.57%(2/7)and the count of CTC was1.29±0.95 in patients with T1,the positive rate of CTC was 85.71%(90/105)and the count of CTC was 3.32±2.92 in patients with T2+T3+T4.The positive rate and the count of CTC of patients with higher T-stage were significantly higher than those with lower T-stage(P=0.002,P=0.021).There was no significant correlation between the positive rate of CTC and the count of CTC with the age,tumor size,tumor location,lymph node metastasis(N stage),distant metastasis(M stage),TNM stage,vessel invasion,nerve invasion,Ki-67 index,CEA and CA19-9(P>0.05).3.The sensitivity,specificity,positive predictive value and negative predictive value of CTC were 82.14%,100%,100% and 33.33%,respectively.The sensitivity of CEA to colorectal cancer was 31.25%,specificity was 100%,positive predictive value was 100%,negative predictive value was 11.49%;the sensitivity of CA19-9 to colorectal cancer was 20.54%,specificity was 90%,positive predictive value was95.83%,negative predictive value was 9.18%.The sensitivity of CTC is much higher than CEA and CA19-9;the specificity is the same as CEA,slightly higher than CA19-9;the positive predictive value is the same as CEA,slightly higher than CA19-9;the negative predictive value is higher than CEA and CA19-9.The area under the ROC curve(AUC),CTC(AUC=0.960),was larger than CEA(AUC=0.685)and CA19-9(AUC=0.814),CTC detection was used to evaluate the largest area under the ROC curve of colorectal cancer.4.There were 41 patients with recurrence or metastasis,the positive rate of CTC was 87.80%,and the count of CTC was 3.83±2.66;71 patients without recurrence or metastasis,the positive rate of CTC was 78.87%,and the count of CTC was 2.83±1.96.The positive rate of CTC in patients with recurrence or metastasis was higher than that in patients without recurrence or metastasis,but the difference was not statistically significant(P=0.234);the count of CTC in patients with recurrence or metastasis was higher than that in patients without recurrence or metastasis,the difference was statistically significant(P=0.025).5.The analysis of progression-free survival curve showed that there was nodifference in the prognosis between CTC positive patients and CTC negative patients(P=0.125).Conclusion: 1.The positive rate and CTC count of colorectal cancer patients were significantly higher than those of benign colorectal disease patients and healthy subjects.2.The CTC of colorectal cancer patients was higher in male,low differentiated and high T stage cancer patients.3.The diagnostic value of CTC for colorectal cancer is higher than CEA and CA19-9;the CTC count of patients with recurrence and metastasis was higher than that of patients without recurrence and metastasis.CTC can be used as a reference index for the diagnosis and prediction of recurrence and metastasis of colorectal cancer.