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目的:研究食管鳞癌(esophagus squamous cell carcinoma,ESCC)患者放疗前后外周血循环肿瘤细胞(circulating tumorcells,CTCs)标记生存素(survivin)mRNA的表达及其临床意义。方法:收集72例ESCC患者根治性放疗前后外周血,应用巢式RT-PCR检测survivin mRNA的表达,分析其与临床病理特征、放疗疗效及两年无进展生存期(progerssion-free survival,PFS)的关系。结果:放疗前后survivin mRNA阳性者分别占54.2%(39/72)与38.9%(28/72),差异无统计学意义(P=0.066),放疗前后survivin mRNA阳性均与淋巴结转移相关(P值分别为0.012和0.005),放疗后survivin mRNA阳性提示放疗疗效不佳(P=0.030)。生存分析表明放疗前后survivin mRNA阳性与PFS减少有关(P值分别为0.040和<0.001),Cox回归模型证实放疗后survivin mRNA阳性、KPS评分和规范化后续化疗是独立预后指标。结论:放疗后外周血survivin mRNA阳性有望成为ESCC根治性放疗疗效评估和预后判断的有效分子标记。
Objective: To investigate the expression of survivin mRNA in peripheral blood circulating tumor cells (CTCs) before and after radiotherapy in patients with esophagus squamous cell carcinoma (ESCC) and its clinical significance. Methods: The peripheral blood samples of 72 patients with ESCC before and after radiotherapy were collected. The expression of survivin mRNA was detected by nested RT-PCR, and its clinical and pathological characteristics, radiotherapy efficacy and two-year progerssion-free survival (PFS) Relationship. Results: The positive rates of survivin mRNA before and after radiotherapy were 54.2% (39/72) and 38.9% (28/72) respectively, with no significant difference (P = 0.066). The positive rates of survivin mRNA before and after radiotherapy were correlated with lymph node metastasis Respectively, 0.012 and 0.005). The positive expression of survivin mRNA after radiotherapy suggested that radiotherapy was ineffective (P = 0.030). Survival analysis showed that the positive expression of survivin mRNA was correlated with the decrease of PFS before and after radiotherapy (P values were 0.040 and <0.001, respectively). Cox regression model confirmed survivin mRNA positive after radiotherapy, KPS score and standardized follow-up chemotherapy were independent prognostic indicators. Conclusion: The positive expression of survivin mRNA in peripheral blood after radiotherapy is expected to be an effective molecular marker for assessing the efficacy and prognosis of ESCC.