循环月中瘤细胞在泌尿系月中瘤的研究进展2

43例行膀胱肿瘤术患者术前血液中CTCs数量，发现其与病理分期没有关联（P=0. 28）。Stein等[22]的研究也证实了这一点。

2.3肾细胞癌
肾细胞癌(RCC)是世界上常见第三大泌尿系恶性肿瘤，发病率每年上涨大约2%[23]，每年新增患者逾10万人，其中20%初诊时已有转移，20～40%术后发生转移[24]。诸多学者发现，外周血中检测到循环肿瘤细胞与肾癌转移、较差预后、化疗效果存在显著关系。Bluemke等[ll]运用免疫磁珠分选技术( MACS)检测了来自154例肾癌患者的233份血液样本中的循环肿瘤细胞，53%患者显示CTCs阳性，其存在与RCC淋巴结转移(P<0．001；X2检验)及RCC术后转移（P=0.014;X2检验）有显著关联。Rossi等[25]学者研究发现，检出抗上皮细胞粘附分子(EpCAM)阳性且有活力的CTCs预示着肿瘤的进展、远处转移，而其数量的下降预示肿瘤无恶性进展。近年来出现了针对转移性肾癌的分子靶向药物（舒尼替尼等），这些药物取得了一定成效。Rossi等[25]研究证实CTCs与化疗药物治疗敏感性相关。通过监测接受治疗患者CTCs水平，发现其上调预示着一线药物舒尼替尼治疗的失败。外周血中CTCs计数可能会更好地评价治疗效果，有助于制定个体化治疗方案，这尚需要进一步深入研究。目前，CTC作为肾细胞癌生物学标志物引发众多兴趣，但是，由于肾细胞癌细胞缺乏特异性表面标志用于筛选，CTC在肾细胞癌研究方面受到一定制约[26]。 3问题与展望 循环肿瘤细胞的研究尚有以下几个方面的问题有待进一步解决：目前CTCs检测主要依靠肿瘤特异性或器官特异性以及肿瘤自身形态特征予以鉴别，无法保证所检测到的肿瘤细胞是真正的、成活的循环肿瘤细胞，且难以与进入血液的正常上皮细胞进行精确区分；对CTCs实验研究尚处于初步发展阶段，缺乏大规模、前瞻性的研究，不能准确评价其在肿瘤转移、患者预后方面的意义，仍不能作为临床个体化治疗的准确实施指标。 循环肿瘤细胞作为表征恶性肿瘤转移潜能的重要生物学标志，在血液中的存在及数量能够反映肿瘤恶性程度、肿瘤治疗的效果及预后。通过改良现有CTCs检测技术．并开展大规模基础研究与临床试验，在检测细胞表面标志物的同时进行基因水平上的探索，可以从分子生物学水平上进一步把握CTCs的特质、阐释肿瘤发展机制，为癌症患者临床分期、预后判断、个体化治疗提供依据。

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