口腔鳞状细胞癌外周血循环肿瘤细胞检测及其临床意义

doi:10.7518/hxkq.2021.05.015

华西口腔医学杂志 ›› 2021, Vol. 39 ›› Issue (5): 591-597.doi: 10.7518/hxkq.2021.05.015

口腔鳞状细胞癌外周血循环肿瘤细胞检测及其临床意义

张帅源(), 秦硕, 李光辉, 易雅群, 付昊杰, 高雅靖, 孙明磊()

郑州大学第一附属医院口腔颌面外科，郑州 450052

收稿日期:2020-11-26 修回日期:2021-07-03 出版日期:2021-10-01 发布日期:2021-10-11
通讯作者: 孙明磊 E-mail:527596513@qq.com;mlsun@zzu.edu.cn
作者简介:张帅源，住院医师，硕士，E-mail：527596513@qq.com
基金资助:
郑州市口腔颌面外科院士工作站项目(152PYSGZ040);河南省医学科技攻关计划省部共建项目(SBGJ202002067)

Detection of peripheral blood circulating tumor cells in oral squamous cell carcinoma and its clinical significance

Zhang Shuaiyuan(), Qin Shuo, Li Guanghui, Yi Yaqun, Fu Haojie, Gao Yajing, Sun Minglei.()

Dept. of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Received:2020-11-26 Revised:2021-07-03 Online:2021-10-01 Published:2021-10-11
Contact: Sun Minglei. E-mail:527596513@qq.com;mlsun@zzu.edu.cn
Supported by:
Zhengzhou Oral and Maxillofacial Surgery Academician Workstation Project(152PYSGZ040);Henan Provincial Medical Science and Technology Project Jointly Built by the Ministry(SBGJ202002067);Correspondence: Sun Minglei, E-mail: mlsun@zzu.edu.cn

摘要/Abstract

摘要： 目的

探讨外周血循环肿瘤细胞（CTCs）检测对口腔鳞状细胞癌（OSCC）的诊断价值及其与OSCC临床病理特征的相关性。

方法

选择2019年5月—2020年5月在郑州大学第一附属医院确诊为OSCC的患者93例为试验组，20例健康志愿者为对照组。检测2组外周血的CTCs值，分析其相关临床意义。

结果

试验组患者CTCs值高于对照组，差异有统计学意义（P<0.000 1）。试验组外周血CTCs值与患者的性别、发病部位、有无周围组织浸润无关（P>0.05），与患者年龄相关（P=0.022）、肿瘤T分期（P=0.02）、N分期（P=0.007 5）、M分期（P=0.013）、临床分期（P=0.029）、早晚期相关（P=0.022）、肿瘤分化程度（P<0.001）和淋巴结转移（P=0.006 4）相关。应用CTCs诊断OSCC的AUC值为0.925，检验能效性有统计学意义[P=0.000，95%CI（0.876，0.974） ]，当CTCs值为8.450 FU/3 mL时，约登指数最大为0.853，诊断OSCC的敏感度为90.3%，特异性95.0%；应用CTCs诊断OSCC转移的AUC值为0.691，检验能效性有统计学意义[P=0.000，95%CI（0.580，0.803） ]，当CTCs值是12.250 FU/3 mL时，约登指数最大为0.367，敏感度为63.6%，特异性73.3%。多因素回归分析表明颊部肿瘤与OSCC患者CTCs值呈负相关（P=0.001 08）；N2分期（P=0.000 74）及M分期（P=0.026 38）与OSCC患者CTCs值呈正相关；肿瘤分化程度中高分化（P<0.000 1）及中分化（P=0.001 5）与OSCC患者CTCs值呈负相关。

结论

外周CTCs的检测，对OSCC的早期筛查、辅助诊断、评估转移以及判断肿瘤的恶性程度、进展情况、病理分级等均有较为重要的临床价值。

关键词: 口腔鳞状细胞癌, 循环肿瘤细胞, 液体活检

Abstract: Objective

This study aims to investigate the diagnostic value of peripheral blood circulating tumor cells (CTCs) in oral squamous cell carcinoma (OSCC) and its correlation with the clinicopathological features of OSCC.

Methods

Ninety-three patients diagnosed as OSCC in the First Affiliated Hospital of Zhengzhou University from May 2019 to May 2020 were selected as the experimental group, and 20 healthy volunteers were employed as the control group. The CTCs value of peripheral blood of the patients were measured by CTCs detection technology, and its clinical significance was analyzed.

Results

The CTCs values in the experimental group were higher than those in the control group, and the difference was statistically significant (P<0.000 1). The CTCs value in the peripheral blood of patients in the experimental group were not correlated with gender, site of onset, and presence or absence of peripheral tissue infiltration (P>0.05), but was correlated with age (P=0.022), tumor T stage (P=0.02), tumor N stage (P=0.007 5), tumor M stage (P=0.013), clinical stage (P=0.029), early or late stage (P=0.022), tumor differentiation degree (P<0.001), and node metastasis (P=0.006 4). The AUC value of CTCs in OSCC diagnosis was 0.925, and the energy efficiency was statistically significant [P=0.000, 95%CI (0.876, 0.974)]. When the CTC value was 8.450 FU/3 mL, the maximum value of the Yoden index was 0.853, and the sensitivity and specificity of OSCC diagnosis were 90.3% and 95.0%, respectively. The AUC value of CTCs in the diagnosis of OSCC metastasis was 0.691, and the energy efficiency was statistically significant [P=0.000, 95%CI (0.580, 0.803)]. When the blood CTC value was 12.250 FU/3 mL, the maximum value of Yoden index was 0.367, the sensitivity was 63.6%, and the specificity was 73.3%. Multivariate regression analysis showed that buccal tumor was negatively correlated with CTCs in patients with OSCC (P=0.001 08), N2 stage (P=0.000 74) and M stage (P=0.026 38). High differentiation (P<0.000 1) and moderate differentiation (P=0.001 5) were negatively correlated with CTCs values in patients with OSCC.

Conclusion

Peripheral blood CTCs has important clinical value for early screening, auxiliary diagnosis, evaluation of metastasis, and determination of malignant degree, progression, and pathological grade of OSCC and a relatively reliable tumor detection indicator.

Key words: oral squamous cell carcinoma, circulating tumor cells, liquid biopsy

中图分类号:

R 739.8

张帅源, 秦硕, 李光辉, 易雅群, 付昊杰, 高雅靖, 孙明磊. 口腔鳞状细胞癌外周血循环肿瘤细胞检测及其临床意义[J]. 华西口腔医学杂志, 2021, 39(5): 591-597.

Zhang Shuaiyuan, Qin Shuo, Li Guanghui, Yi Yaqun, Fu Haojie, Gao Yajing, Sun Minglei.. Detection of peripheral blood circulating tumor cells in oral squamous cell carcinoma and its clinical significance[J]. West China Journal of Stomatology, 2021, 39(5): 591-597.

图/表 6

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参考文献 23

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临床病理特征		OSCC患者/n（%）	P值
性别	男	64（68.8%）	0.19
性别	女	29（31.2%）	0.19
年龄/岁	<60	68（73.1%）	0.022
年龄/岁	≥60	25（26.9%）	0.022
发病部位	舌	39（41.9%）	0.064
	颊	12（12.9%）
	颌骨	18（19.4%）
	牙龈	11（11.8%）
	口底	8（8.6%）
	其他	5（5.4%）
分化程度	低分化	15（16.1%）	<0.001
	中分化	59（63.4%）
	高分化	19（20.4%）
淋巴结转移	无	65（69.9%）	0.006 4
淋巴结转移	有	28（30.1%）	0.006 4
周围组织浸润	无	59（63.4%）	0.062
周围组织浸润	有	34（36.6%）	0.062
T分期	T1	29（31.2%）	0.02
	T2	26（28.0%）
	T3	4（4.3%）
	T4	34（36.6%）
N分期	N0	65（69.9%）	0.007 5
	N1	13（14.0%）
	N2	15（16.1%）
M分期	M0	82（88.2%）	0.013
M分期	M1	11（11.8%）	0.013
临床分期	Ⅰ	27（29.0%）	0.029
	Ⅱ	15（16.1%）
	Ⅲ	11（11.8%）
	Ⅳ	40（43.0%）
早晚期	Ⅰ+Ⅱ	52（54.8%）	0.022
早晚期	Ⅲ+Ⅳ	41（45.1%）	0.022

特征		OR值	P值
部位	舌	-0.674	0.244 55
	颊	-2.516	0.001 08
	牙龈	-0.625	0.426 49
	口底	0.524	0.543 68
	其他	0.293	0.776 80
N分期	N1	0.373	0.545 71
N分期	N2	2.181	0.000 74
M分期	M1	1.553	0.026 38
分化程度	高分化	-3.541	<0.000 1
分化程度	中分化	-1.982	0.001 5

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口腔鳞状细胞癌外周血循环肿瘤细胞检测及其临床意义

Detection of peripheral blood circulating tumor cells in oral squamous cell carcinoma and its clinical significance

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