晚期胰腺癌患者门静脉血循环肿瘤细胞检测的临床应用价值

Objective To investigate the feasibility,safety,and clinical application values of interventional radiology techniques in acquiring circulating tumor cells (CTCs) from portal vein in patients with advanced pancreatic cancer. Methods From Feb.,2016 to Dec.,2016,patients diagnosed with advanced pancreatic cancer in the Department of Interventional Radiology,Zhongshan Hospital,Fudan University were enrolled in this study.Percutaneous transhepatic portal vein puncture were performed with a 21 G needle under the guidance of ultrasound and 15 mL portal vein blood were obtained for each patient before transarterial chemotherapy/chemoembolization.In some patients,7.5 mL peripheral vein blood was also obtained.CTCs were enriched by ClearCell system.EpCAM/CK19/DAPI triple positive cells were considered as CTCs and were counted using immunofluorescence assay.CTCs cell counts were compared between the portal vein blood and peripheral vein.The correlations of CTCs and clinical/pathological characteristics of the patients were analyzed.The stem cell characteristic of CTCs was observed both in portal vein and peripheral vein. Results Percutaneous transhepatic portal vein puncture and portal vein blood sampling was successfully performed in 29 pancreatic cancer patients without technique related complications.The mean counts of portal vein CTCs was (282±50)/7.5 mL in all 29 patients.In 14 patients with both portal vein and peripheral vein sample obtained,the mean counts of CTCs in portal vein was significantly higher than that in the peripheral vein blood ［(237±78)/7.5 mL vs.(21±7)/7.5 mL,P=0.010 2)］.In portal vein samples,the mean counts of CTCs in patients with liver metastasis was significantly higher than patients without liver metastasis ［(449±81)/7.5 mL) vs.(26±18)/7.5 mL,P=0.000 4)］.The percetage of CD133+ CTCs was 5.9% in portal vein,while no CD133+ CTCs was found in peripheral vein. Conclusions Percutaneous transhepatic portal vein puncture using a 21 G needle for portal vein blood sampling under the guidance of ultrasound was safe and feasible for patients with advanced pancreatic cancer.CTCs counting was significantly higher in the portal vein than peripheral vein.Portal vein CTCs counting was correlated with liver metastasis status.Stem characteristic CTCs can be found in portal vein.