The Value Of Circulating Tumor Cells In Evaluating The Efficacy Of Chemotherapy In Patients With Advanced Breast Cancer

Objective:Circulating tumor cells(CTC),as a kind of real-time detection of liquid biopsy marker,have real-time monitoring function and it is a new non-invasive diagnostic tool.Its accurate counting and biological characteristics can provide more important and comprehensive information for the prediction of therapeutic efficacy evaluation and prognosis of cancer patients.In this study,we examined the number of circulating tumor cells in peripheral blood during chemotherapy in patients with advanced breast cancer.To explore whether CTCs count can be used to evaluate the effect of chemotherapy earlier and the number of CTCs detected at different times can be used to assess the progression of the disease.Methods:(1)From July 2016 to June 2018,50 cases of patients diagnosed with advanced breast cancer in department of thyroid and breast surgery of Liaocheng People’s Hospital were selected as research objects,and relevant clinical data were collected.(2)The peripheral venous blood(3.2ml)of the patient was collected in vacuum tube,and“negative enrichment(NE)”CTCs,immunocytochemistry CD45 staining and fluores-cence in situ hybridization were applied(FISH)method was used to identify circulating tumor cells.Under fluorescence microscope,cells that meet the requirements of nuclear DAPI positive,bloodless leukocyte surface antigen CD45 negative and FISH signal points>2 in the nucleus were defined as circulating tumor cells(DAPI+/CD45-/Chromosome polyploid).(3)The number of CTCs in peripheral blood was measured during the rescue che-motherapy of patients with advanced breast cancer,and the clinical data of imaging and serological indicators were collected at the same period.The changes in the number of CTCs during chemotherapy were compared and statistical analysis was conducted by combining the imaging data and serological indexes of the patients.(4)The data were statistically processed using SPSS23.0 analysis software.The measurement data was expressed as?x±s.The analysis of frequency data was performed by the paired Chi-square(χ~2)and kappa consistency test.The test level wasα=0.05 and P<0.05 was believed that the difference was statistically significant.kappa ranges from 0to 1.The consistency of kappa(>0.75)is good,that of kappa(>0.4)is general,and that of kappa<0.4 is poor.Results:(1)Among the 50 patients with advanced breast cancer who were enrolled in the study,there is one male patient and the rest are all females.In all patients,18 patients with CTCs counted≥5 for the first time(accounting for 36%).There were 28 cases of 5>CTCs≥1(56%of the total),of which 4 cases were not found at the first time(accounting for 8%),so the positive rate of CTCs found in the first test was 92%.(2)The number of CTCs in peripheral blood of the patients was periodically reviewed during rescue chemotherapy,including 32 patients with increased CTCs count and 18patients with decreased CTCs count.The imaging data of patients with increased CTCs count were collected at the same time.Among those with increased CTCs count,29 cases imaging data showed progress and 3 cases did not progress.The changes of CTCs count during chemotherapy and the imaging data were used to evaluate the therapeutic effect of diseases.Statistical analysis showed that there was no statistical difference between the two groups.(χ~2=0.125,P>0.05).(3)In the course of chemotherapy for advanced breast cancer,the changes of serolo-gical indexes(CEA2 A,CK19,BR15-3Ag)and the evaluation results of imaging efficacy were statistically analyzed,with poor consistency and statistically significant differences.CEA2 A(kappa=0.19,χ~2=4.27,P<0.05),CK19(kappa=0.16,χ~2=6.67,P<0.05),BR15-3Ag(kappa=0.01,χ~2=4.5,P<0.05).(4)Taking imaging evaluation as a standard,comparing the changes of CTCs detec-tion number with serological indicators,the consistency between CTC and imaging indi-cators is high,while the consistency between serological tumor markers is poor.Conclusion:(1)In the advanced breast patients,the number of CTCs counted for the first time has a certain clinical application value in predicting the development of the disease.Attention should be paid when circulating tumor cells are found in peripheral venous blood of breast cancer patients.(2)In the process of rescue chemotherapy in patients with advanced breast cancer,the changes of CTCs were compared with the imaging results,and no statistical difference was obtained.(3)In the treatment of advanced breast cancer patients,the serological indicators(CEA2 A,CK19,BR15-3Ag)were statistically different from the results of imaging evaluation.There was statistical significance in predicting the risk of disease progression.Serological indicators were not as sensitive as imaging indicators,and serological indicators could not accurately reflect the changes of disease.(4)In the treatment process of chemotherapy drugs for patients with advanced breast cancer,taking imaging as the standard,the change trend of CTCs count is compared and analyzed with the three items of serological tumor markers(CEA2 A,CK19,BR15-3Ag).The consistency of serological tumor markers is not as good as that of CTC.To some extent,the application of CTCs count change to predict the risk of disease progression is more sensitive than serological indicators.