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中华乳腺病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (02) : 105 -108. doi: 10.3877/cma.j.issn.1674-0807.2016.02.009

综述

循环肿瘤细胞在转移性乳腺癌治疗及预后评价中的应用进展
郝帅1, 田武国1, 孙启慧1, 高博1, 罗东林1,()   
  1. 1.400042 重庆,第三军医大学大坪医院野战外科研究所乳腺甲状腺血管外科
  • 收稿日期:2015-12-11 出版日期:2016-04-01
  • 通信作者: 罗东林
  • 基金资助:
    国家科技惠民计划项目(2013GS500101-05)

Application of circulating tumor cells in treatment and prognosis of metastatic breast cancer

Shuai Hao, Wuguo Tian, Qihui Sun, Bo Gao, Donglin Luo()   

  • Received:2015-12-11 Published:2016-04-01
  • Corresponding author: Donglin Luo
引用本文:

郝帅, 田武国, 孙启慧, 高博, 罗东林. 循环肿瘤细胞在转移性乳腺癌治疗及预后评价中的应用进展[J/OL]. 中华乳腺病杂志(电子版), 2016, 10(02): 105-108.

Shuai Hao, Wuguo Tian, Qihui Sun, Bo Gao, Donglin Luo. Application of circulating tumor cells in treatment and prognosis of metastatic breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2016, 10(02): 105-108.

循环肿瘤细胞(CTCs)是恶性肿瘤患者外周血循环中的肿瘤细胞,来源于原发肿瘤或从转移性病灶脱落入血。 外周血CTCs 检测已成为一种高度可行且可重复的非侵入性新型诊断方法。 CTCs的血源性传播在乳腺癌转移、进展中起到重要的作用。 CTCs 检测既能评估临床干预措施的疗效及患者的预后,又可作为分析患者肿瘤生物学特征的实时样本,及时发现肿瘤的生物学变化。 临床医师可根据CTCs 检测结果及时调整患者的治疗方案,从而实现个体化治疗。 目前,在基因和分子生物学水平对CTCs 的研究已广泛开展,有望为转移性乳腺癌的治疗提供新的靶点。 本文主要介绍CTCs 检测在转移性乳腺癌治疗及预后评估中的应用进展。

表1 常用循环肿瘤细胞富集及检测方法及特点
技术 描述 优点 缺点
膜滤过分离法[15] 依据细胞大小使用孔径约8 μm 滤膜分离CTCs 分离计数可操作性强,保存细胞活性便于后续分析 CTCs纯度低,特异性较差
CellSearch系统[16] 用EpCAM抗体包被的铁磁珠免疫分离(用CK8、CK18、CK19, CD45和DAPI标记进行检测) 半自动,敏感度高,可重复性高,标记、鉴定和计数均有明确的标准,FDA唯一认可 依赖EpCAM阳性的细胞,假阴性率较高,不能进行CTCs基因表达分析,价格昂贵
免疫细胞化学技术[17] 在细胞富集的基础上,针对肿瘤细胞特异蛋白或基因进行原位检测,并对筛选后的细胞进行鉴定 能够进行CTCs计数检测及形态学分析,直观且操作简便 敏感度和特异度较低,主观性较强
上皮细胞免疫斑点法[18] 通过检测细胞分泌或被激活所释放的特异性蛋白来鉴定蛋白分泌型细胞 能够区分凋亡细胞和活性CTCs 缺乏CTCs进一步富集与检测的潜力
CTC-chip[19] 使用含包被EpCAM抗体微柱阵列的芯片 检测率高,便于计数及分子表型分析 依赖EpCAM阳性的细胞,特异度有待提高
RT-PCR(CTCscope)[20] 基于肿瘤特异性基因的表达分析 敏感度高 CTCs数量检测准确性较差,缺乏形态学分析
AdnaTestCancer癌细胞检测系统[21] 通过特定抗原表达和肿瘤相关标志物分离,提取RNA进行RT-PCR分析 敏感度与特异度均高,有助于区分CTCs的干细胞属性与表型变化 缺乏形态学分析,非肿瘤细胞表达相关分子可致假阳性,表型异质性可致假阴性
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