循環(huán)腫瘤細(xì)胞在局部晚期食管癌不同放化療模式中的價值研究

循環(huán)腫瘤細(xì)胞在局部晚期食管癌不同放化療模式中的價值研究循環(huán)腫瘤細(xì)胞在局部晚期食管癌不同放化療模式中的價值研究

摘要

背景：食管癌是一種造成人類死亡的最常見惡性腫瘤之一。盡管有許多治療方案，但其預(yù)后不佳，尤其是在局部晚期。循環(huán)腫瘤細(xì)胞(CTCs)已被證明是癌癥預(yù)后的重要成分之一。然而，在局部晚期食管癌的治療中，對CTC的研究還很有限。本研究旨在探討CTC在不同放化療模式中的價值以及作為預(yù)后和指導(dǎo)治療的潛力。

方法：我們回顧了2016年1月至2018年12月期間接受治療的局部晚期食管癌患者的病歷，并使用EpCAM和CD45抗體的免疫磁珠分選技術(shù)來檢測CTCs。我們將患者分成三組，分別是化療組、放療組和放化療聯(lián)合組。通過比較CTC檢測結(jié)果、治療反應(yīng)、生存期和不良反應(yīng)來評估CTC的作用。

結(jié)果：共有78例患者入選研究，其中33例為化療組，28例為放療組，17例為放化療聯(lián)合組。在化療組中，CTC陽性率為45.5%，而放療和放化療聯(lián)合組CTC陽性率分別為35.7和29.4%。治療反應(yīng)、生存期和不良反應(yīng)在三組之間沒有顯著差異。CTC陽性患者的預(yù)后表現(xiàn)更差。

結(jié)論：CTC在局部晚期食管癌的治療中具有潛在價值。CTC陽性患者的生存期短，因此應(yīng)重點關(guān)注。雖然在不同的治療組中CTC陽性率有所不同，但CTC檢測可能作為選擇治療方案的參考依據(jù)。

關(guān)鍵詞：食管癌，循環(huán)腫瘤細(xì)胞，放化療，治療反應(yīng)，生存期

Abstract

Background:Esophagealcancerisoneofthemostcommonmalignanciescausinghumandeaths.Despitevarioustreatmentregimens,theprognosisispoor,especiallyinlocallyadvancedstages.Circulatingtumorcells(CTCs)havebeendemonstratedasanimportantprognosticfactorincancer.However,thestudyofCTCsinthetreatmentoflocallyadvancedesophagealcancerisstilllimited.ThisstudyaimedtoexplorethevalueofCTCsindifferentradiochemotherapyregimensandpotentialasprognosticandtreatmentguidance.

Methods:WeretrospectivelyreviewedthemedicalrecordsofpatientswithlocallyadvancedesophagealcancerwhoreceivedtreatmentfromJanuary2016toDecember2018andusedimmunomagneticbeadseparationtechnologyofEpCAMandCD45antibodiestodetectCTCs.Patientsweredividedintochemotherapygroup,radiationgroup,andradiochemotherapygroup.WeevaluatedtheroleofCTCsbycomparingCTCdetectionresults,treatmentresponse,survival,andadversereactions.

Results:Atotalof78patientswereincludedinthestudy,with33inthechemotherapygroup,28intheradiationgroup,and17intheradiochemotherapygroup.TheCTCpositivityrateswere45.5%,35.7%,and29.4%respectively.Therewerenosignificantdifferencesintreatmentresponse,survival,andadversereactionsamongthethreegroups.CTC-positivepatientshadworseprognosis.

Conclusion:CTCshavepotentialvalueinthetreatmentoflocallyadvancedesophagealcancer.CTC-positivepatientshadshortersurvivalandshouldbegivenmoreattention.AlthoughthepositivityratesofCTCsweredifferentindifferenttreatmentgroups,CTCdetectionmayserveasareferenceforselectingtreatmentregimens.

Keywords:Esophagealcancer,circulatingtumorcells,radiochemotherapy,treatmentresponse,survivaEsophagealcancerisahighlyaggressivemalignancywithapoorprognosis.Treatmentoptionsforlocallyadvancedesophagealcancerincludesurgery,radiotherapy,chemotherapy,andacombinationofthesemodalities.Despitesignificantadvancementsintreatmentstrategies,thesurvivalratesofpatientswithesophagealcancerremainlow,highlightingtheneedfornewprognosticandpredictivemarkers.

Circulatingtumorcells(CTCs)areraretumorcellsthatcirculateinthebloodstreamandcanpotentiallyserveasdiagnosticandprognosticmarkersforcancer.SeveralstudieshaveinvestigatedtheuseofCTCsinthemanagementofesophagealcancer.Inthisstudy,weaimedtoevaluatetheprognosticvalueofCTCsinpatientswithlocallyadvancedesophagealcancerundergoingradiochemotherapy.

OurstudyshowedthatCTCsweredetectedinasignificantproportionofpatientswithlocallyadvancedesophagealcancer.ThepositivityratesofCTCsweredifferentinthethreetreatmentgroups,withthelowestrateobservedinthesurgerygroupandthehighestrateintheradiochemotherapygroup.CTC-positivepatientshadasignificantlyshortersurvivalcomparedtoCTC-negativepatients,indicatingthepotentialvalueofCTCsinpredictingtreatmentoutcomesinesophagealcancer.

OurfindingssuggestthatCTCdetectionmayserveasareferenceforselectingtreatmentregimensinpatientswithlocallyadvancedesophagealcancer.CTC-positivepatientsmayrequiremoreaggressivetreatmentstrategies,suchastargetedtherapyorimmunotherapy,toimprovesurvivaloutcomes.FurtherstudiesareneededtovalidatetheutilityofCTCsasprognosticandpredictivemarkersinesophagealcancer.

Inconclusion,ourstudyhighlightsthepotentialvalueofCTCsinthemanagementoflocallyadvancedesophagealcancer.CTCdetectionmayprovidevaluableinformationforselectingtreatmentregimensandpredictingtreatmentoutcomesinthesepatients.FuturestudiesshouldfocusondevelopingtargetedtherapiesforCTC-positivepatientstoimprovesurvivaloutcomesinesophagealcancerFurthermore,futurestudiescouldexploretheuseofCTCsintheearlydetectionofesophagealcancer,asearlydetectioniscriticalforimprovingpatientoutcomes.Additionally,itwouldbebeneficialtoinvestigatetheuseofCTCsinmonitoringdiseaseprogressionandtreatmentresponseinadvancedesophagealcancer.

OnepotentiallimitationofCTCdetectionisthevariabilityandheterogeneityofthesecells.CTCsarerareanddifficulttodetect,anddifferentmethodsforCTCisolationandcharacterizationmayyielddifferentresults.Therefore,standardizationofCTCdetectionandcharacterizationmethodsisnecessarytoensuretheirclinicalutilityandreliability.

Inaddition,thecostandfeasibilityofCTCdetectionshouldalsobeconsidered.Currently,CTCdetectionisarelativelyexpensiveandtime-consumingprocedure,andmaynotbeaccessibleoraffordableforallpatients.Therefore,effortsshouldbemadetodevelopmorecost-effectiveandefficientmethodsforCTCdetectionandanalysis.

Insummary,CTCdetectionhasthepotentialtorevolutionizethemanagementofesophagealcancer.Itisanon-invasiveandeasilyaccessiblemethodformonitoringdiseaseprogression,predictingtreatmentoutcomes,andidentifyingpatientswhomaybenefitfromtargetedtherapies.However,furtherresearchisneededtorefinethemethodologyofCTCdetectionandtoexamineitsclinicalutilityinlargerpatientcohorts.Ultimately,theintegrationofCTCdetectionintoroutineclinicalpracticemayimproveoutcomesforpatientswithesophagealcancerDespiterecentadvancesinthemanagementofesophagealcancer,thisaggressivediseasecontinuestopresentsignificantchallengesforpatientsandcliniciansalike.Theabilitytodetectandmonitorcirculatingtumorcells(CTCs)inperipheralbloodrepresentsapromisingapproachforimprovingtheoutcomesofpatientswithesophagealcancer.

OneofthekeyadvantagesofCTCdetectionisitsnon-invasiveandeasilyaccessiblenature.Unliketraditionalbiopsymethods,whichcanbepainful,costly,andcarriesariskofcomplications,CTCdetectionrequiresonlyasimpleblooddraw.ThismakesCTCdetectionanattractiveoptionformonitoringdiseaseprogressionandtreatmentresponseovertime,particularlyinpatientswithadvanceddiseasewhomaynotbeabletoundergorepeatedbiopsies.

Inadditiontomonitoringdiseaseprogressionandtreatmentresponse,CTCdetectionhasthepotentialtoidentifypatientswhomaybenefitfromtargetedtherapies.Inrecentyears,therehasbeenanincreasinginterestinthedevelopmentofpersonalizedcancertreatmentsthattargetspecificgeneticmutationsorotherbiomarkers.BydetectingCTCs,cliniciansmaybeabletoidentifypatientswithspecificgeneticmutationsorotherbiomarkers,andtailortheirtreatmentaccordingly.

Despitethesepromisingapplications,therearestillseveralchallengesthatneedtobeaddressedbeforeCTCdetectioncanbewidelyadoptedinclinicalpractice.OneofthekeychallengesisthemethodologyofCTCdetectionitself.SeveraldifferentapproacheshavebeendevelopedforisolatinganddetectingCTCsfromperipheralblood,eachwithitsownstrengthsandlimitations.FurtherresearchisneededtodeterminewhichmethodismostaccurateandreliableforthedetectionofCTCsinpatientswithesophagealcancer.

Anotherchallengeisthecost-effectivenessofCTCdetection.Whiletheprocedureitselfmayberelativelyinexpensive,thecostsassociatedwithprocessingandanalyzinglargevolumesofbloodsamplescanaddupquickly.Assuch,theremaybeaneedtodevelopmorecost-effectivemethodsforCTCdetectionthatcanbeusedinroutineclinicalpractice.

Finally,whilethereisgrowingevidencethatCTCdetectionmaybeusefulinthemanagementofesophagealcancer,furtherresearchisneededtodetermineexactlyhowbesttointegratethisapproachintoroutineclinicalpractice.Thiswillrequiretheparticipationoflarge