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標題Title: Persistent Presence of Postoperative Circulating Tumor Cells is a Poor Prognostic Factor for Patients with Stage I–III Colorectal Cancer after Curative Resection
作者Authors: 溫義輝,Chien-Yu Lu..等
上傳單位Department: 生物科技系
上傳時間Date: 2009-11-16
上傳者Author: 溫義輝
審核單位Department: 生物科技系
審核老師Teacher: 溫義輝
檔案類型Categories: 論文Thesis
關鍵詞Keyword: Circulating tumor cells—Molecular markers—Colorectal cancer—Prognosis—, Postoperative surveillance.
摘要Abstract: Aim: To detect pre- and postoperative circulating tumor cells (CTCs) in stage I–III colorectal
cancer (CRC) patients undergoing curative resection and so identify a subgroup of
patients who are at high risk for relapse.
Methods: Four mRNA molecular markers including human telomerase reverse transcriptase,
cytokeratin-19, cytokeratin-20, and carcinoembryonic antigen mRNA were used to detect
CTCs in 438 CRC patients underwent curative resection.
Results: Out of 438 patients, 80 CRC patients were classified to preoperative ()/postoperative
(), 221 patients were preoperative (+)/postoperative (), while 137 patients were
preoperative (+)/postoperative (+). Univariately, postoperative relapse was significantly
correlated with depth of invasion (P = 0.032), lymph node metastasis (P\0.001), vascular
invasion (P = 0.001), perineural invasion (P = 0.013), and persistent presence of CTCs
(P\0.001). Using a multivariate proportional hazards regression analysis, the presence of
lymph node metastasis (P = 0.012; HR, 7.652; 95% CI: 4.162–14.827), vascular invasion
(P = 0.033; HR, 4.360; 95% CI: 2.793–10.847), and the persistent presence of CTCs
(P\0.001; HR, 29.486; 95% CI: 10.281–87.792) were demonstrated to be independent predictors
for postoperative relapse. Combination of these three independent predictors showed
that patients with any one positive predictor had a hazard ratio of sevenfold to develop
postoperative relapse (P\0.001; HR, 7.064; 95% CI: 4.354–11.464). Furthermore, the persistent presence of CTCs was strongly correlated with poorer relapse-free survival rates (all
P\0.001).
Conclusion: The promising results of this study suggest that persistent presence of postoperative
CTCs may be a crucial prognostic factor adjuvant to conventional tumor markers in
CRC patients who have undergone curative resection. Identification of these high-risk patients
of persistent CTCs positivity is important and thus could help to define patients for adjuvant
therapy with this tumor entity.

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