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外周血循环肿瘤细胞联合血清胃泌素释放肽前肽检测对非小细胞肺癌化疗效果及进展评估的价值分析
作者：魏声泓1  任小平1  徐灵彬1  熊洁1  韩冬1  李艳1  刘昱2  吴贵福3 
单位：1. 陕西省人民医院 呼吸内科, 陕西 西安 710068;
2. 西安交通大学第一附属医院 重症医学科, 陕西 西安 710061;
3. 陕西省人民医院 内分泌科, 陕西 西安 710068
关键词：非小细胞肺癌 外周血循环肿瘤细胞 血清胃泌素释放肽前肽 化疗效果 无进展生存期 
分类号：R734.2
出版年·卷·期（页码）：2022·50·第三期（300-305）
摘要：

目的：分析外周血循环肿瘤细胞(CTCs)联合血清胃泌素释放肽前肽(proGRP)检测对非小细胞肺癌化疗效果及预后进展评估的价值。方法：选择2018年10月至2019年10月在陕西省人民医院住院进行化疗的114例非小细胞肺癌患者作为肺癌组，同时选取进行体检的80例健康人群作为健康对照组。检测健康对照组、肺癌组化疗前后外周血CTCs以及血清proGRP水平，采用卡方检验及t检验进行差异分析。化疗结束后，依据世界卫生组织(WHO)制定的肿瘤客观评价疗效标准判定患者化疗疗效，分析肺癌患者化疗疗效与外周血CTCs及血清proGRP水平的关系，随访统计肺癌患者无进展生存期(PFS)，多因素Cox回归分析影响患者预后的因素，Kaplan-Meier法分析患者无进展生存率与化疗后患者外周血CTCs及血清proGRP水平之间的关系。结果：健康对照组外周血中均未检测到CTCs，肺癌组患者外周血CTCs阳性率及血清proGRP水平均显著高于健康对照组(P<0.05)。与化疗前相比，肺癌患者化疗后外周血CTCs阳性率和血清proGRP水平均显著降低(P<0.05)；部分缓解(PR)患者化疗后外周血CTCs阳性率和血清proGRP水平显著低于化疗前，差异有统计学意义(P<0.05)；稳定(SD)患者化疗后外周血CTCs阳性率和血清proGRP水平与化疗前比较差异无统计学意义(P>0.05)；进展(PD)患者化疗后外周血CTCs阳性率和血清proGRP水平显著高于化疗前，差异有统计学意义(P<0.05)。CTCs阳性和proGRP高水平是影响患者预后不良的危险因素(P<0.05)；化疗后外周血CTCs阳性患者的无进展生存率与阴性患者相比显著降低(χ2=18.347，P<0.001)；化疗后血清proGRP高水平患者的无进展生存率显著低于低水平患者(χ2=48.339，P<0.001)。结论：外周血CTCs和血清proGRP水平与患者化疗疗效及预后具有相关性，可作为患者化疗疗效和预后预测指标。

Objective: To analyze the value of peripheral blood circulating tumor cells(CTCs) combined with serum pro-gastrin releasing peptide(proGRP) in the evaluation of chemotherapy effect and prognosis of non-small cell lung cancer. Methods: A total of 114 patients with non-small cell lung cancer who received chemotherapy in our hospital from October 2018 to October 2019 were selected as lung cancer group, and 80 healthy who received physical examination in our hospital were selected as healthy control group. The levels of CTCs in peripheral blood and proGRP in serum of healthy, patients before and after chemotherapy were detected, chi-square test and t test were used to analyze differences. After chemotherapy, the chemotherapy efficacy of patients was determined according to the criteria of objective evaluation of tumor efficacy formulated by the World Health Organization(WHO), the relationship between chemotherapy efficacy and the levels of CTCs in peripheral blood and proGRP in serum of patients with lung cancer was analyzed, and the progression free survival(PFS) was calculated, the prognostic factors were analyzed by multivariate Cox regression analysis, the relationship between the progression free survival rate and the levels of CTCs in peripheral blood and proGRP in serum was analyzed by Kaplan-Meier method. Results: CTCs were not found in the peripheral blood of the healthy control group, and the positive rate of CTCs in lung cancer patients was 85.96%, and compared with that in the healthy control group, the level of serum proGRP in lung cancer patients was significantly higher(P<0.05). Compared with before chemotherapy, the positive rate of CTCs in peripheral blood and level of proGRP in serum of lung cancer patients after chemotherapy were significantly lower(P<0.05); in patients with partial remission(PR) after chemotherapy, the positive rate of CTCs in peripheral blood and level of proGRP in serum were significantly lower than those before chemotherapy(P<0.05), in patients with stabilization(SD), there was no significant difference in the positive rate of CTCs in peripheral blood and level of proGRP in serum before and after chemotherapy(P>0.05), in patients with progress(PD) after chemotherapy, the positive rate of CTCs in peripheral blood and level of proGRP in serum were significantly higher than those before chemotherapy(P>0.05). Positive CTCs and high levels of proGRP were risk factors for poor prognosis in patients(P<0.05), after chemotherapy, progression free survival of CTCs positive patients was significantly lower than that of CTCs negative patients(χ2= 18.347, P<0.001); progression free survival of patients with high serum proGRP level after chemotherapy was significantly lower than that of patients with low serum proGRP level(χ2= 48.339, P<0.001). Conclusion: The levels of CTCs in peripheral blood and proGRP in serum are correlated with chemotherapy efficacy and prognosis of lung cancer patients, which can be used as indicators of chemotherapy efficacy detection and prognosis prediction.
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