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目的:检测HER-2阳性的早期乳腺癌患者应用曲妥珠单抗治疗前后外周血循环肿瘤细胞(CTCs)的变化,探讨HER-2基因及曲妥珠单抗对CTCs的影响。方法:应用实时定量逆转录-聚合酶链反应(qRT-PCR)方法检测15例HER-2阳性乳腺癌及18例HER-2阴性乳腺癌患者术前及化疗后外周血CK19的表达水平,其中10例HER-2阳性乳腺癌患者在化疗结束后,继续应用曲妥珠单抗治疗,3月后再次抽取外周血,qRT-PCR检测CK-19的表达水平。结果:手术前,HER-2阳性乳腺癌患者外周血CK19表达均为阳性,而HER-2阴性患者6例CK19表达阳性(33.3%),二者差异显著。化疗后,14例HER-2阳性乳腺癌患者CK19表达阳性(93.3%),而HER-2阴性患者仅2例表达阳性,二者差异显著。10例HER-2阳性乳腺癌患者化疗后继续应用曲妥珠单抗治疗3月后,外周血CK19的表达明显下降(81.66±68.65 vs 23.35±19.27,P=0.025)。结论:HER-2基因的表达与早期乳腺癌患者外周血CTCs密切相关,而曲妥珠单抗可以降低CTCs的数量,提示CTCs可以作为曲妥珠单抗治疗疗效的早期预测指标。
Objective: To detect the changes of peripheral blood circulating tumor cells (CTCs) in patients with HER-2-positive early breast cancer before and after trastuzumab treatment and to explore the effect of HER-2 gene and trastuzumab on CTCs. Methods: The expression of CK19 in 15 cases of HER-2 positive breast cancer and 18 cases of HER-2 negative breast cancer was detected by qRT-PCR before and after chemotherapy. The expression of CK19 in peripheral blood was detected by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) Ten patients with HER-2-positive breast cancer were treated with trastuzumab after the chemotherapy was completed. Peripheral blood was taken again after 3 months and the expression of CK-19 was detected by qRT-PCR. Results: CK19 expression was positive in peripheral blood of patients with HER-2 positive breast cancer prior to surgery, while CK19 was positive in 6 of HER-2 negative patients (33.3%), both of which were significantly different. CK19 expression was positive in 93 HER-2 positive breast cancer patients (93.3%) after chemotherapy, while only 2 positive cases in HER-2 negative patients showed significant difference. In 10 patients with HER-2 positive breast cancer, the expression of CK19 in peripheral blood was significantly decreased (P = 0.025, 81.66 ± 68.65 vs 23.35 ± 19.27, P = 0.025) after treatment with trastuzumab for 3 months. Conclusion: The expression of HER-2 gene is closely related to CTCs in peripheral blood of patients with early-stage breast cancer. Trastuzumab can reduce the number of CTCs, suggesting that CTCs can be used as an early predictor of the efficacy of trastuzumab.