目的：探讨外周血循环肿瘤细胞（circulating tumor cell,CTC）数量联合胃泌素释放前肽（gastrin releasing peptide,pro-GRP）及神经元特异性烯醇化酶（neuron specific enolase,NSE）对小细胞肺癌(small cell lung cancer, SCLC)患者化疗疗效的评估意义。方法： 收集2015年10月1日至2016年12月30日长海医院呼吸与危重症科收治的40例SCLC患者作为观察对象，分别于第1、3周期化疗前抽取患者外周血，检测其CTC、pro-GRP及NSE水平，分析CTC数目及其联合pro-GRP、NSE水平与化疗疗效的关系；第1、3周期化疗前行胸部CT，对比CTC、pro-GRP及NSE联合判断化疗疗效与实体瘤疗效评价标准(response evaluation criteria in solid tumors, RECIST)标准判断化疗疗效的差异性；分析CTC数与患者临床特征的关系。结果：40例SCLC患者中初次、二次检测到CTC的阳性率为825%、875%。化疗后外周血CTC数下降越多，疗效越好。根据RECIST标准，肿瘤进展组与肿瘤控制组CTC的变化差异有统计学意义（P＜0.05）。CTC数目评价标准下，肿瘤控制与否与患者的年龄、性别、吸烟与否、初诊时肿瘤大小、肿瘤分期无明显关联（P>0.05）。CTC数目评价化疗疗效与RECIST两者存在一致性。联合检测CTC、pro-GRP及NSE，三者量值评价化疗疗效与RECIST疗效评价结果同样一致（P>0.05），且三者联合检测可提高疗效判断的灵敏性。结论： CTC数目与化疗疗效呈负相关，联合检测CTC、pro-GRP及NSE评估SCLC患者化疗疗效灵敏性更高。

Objective:To explore the significance of peripheral blood circulating tumor cells (CTCs) combined with gastrin releasing peptide (pro-GRP) and neuron specific enolase (NSE) in evaluating the chemotherapy efficacy for small cell lung cancer (SCLC) patients. Methods: Forty SCLC patients treated in the department of respiratory and critical care of Changhai Hospital from October 1, 2015 to November 30, 2016 were included in this study. The peripheral blood was extracted from patients before the chemotherapy of first and third cycle to determine the level of CTCs, pro-GRP and NSE, and to analyze their relationship to the efficacy of chemotherapy. Meanwhile, all patients underwent the chest CT before the first and the third cycle of chemotherapy, to compare the differences between CTCs combined with pro-GRP, NSE evaluation and RECIST standard in judging the efficacy of chemotherapy. In addition, the correlation between CTCs number and clinical characteristics of patients were also analyzed. Results: In 40 SCLC patients, the CTCs positive rates detected at two times were 82.5%, 87.5%, respectively. The more CTCs number decreased after chemotherapy, the better effect of chemotherapy was. According to RECIST criteria, there was significant difference in the change of CTCs number between tumor progression group and tumor control group(P<0.05). According to CTCs number evaluation criteria, tumor control was not significantly correlated with age, sex, smoking, tumor size and tumor stage (P<0.05).There was a consistency in evaluating the efficacy of chemotherapy between CTCs number evaluation criteria and RECIST criteria (P>005). Combined detection of CTCs, pro-GRP and NSE in evaluating the chemotherapy efficacy has the same result as RECIST evaluation (P>0.05), and the joint detection can improve the sensitivity of efficacy judgment. Conclusion:There was a negative correlation between the change of CTCs number and the efficacy of chemotherapy. Combing detection of CTCs, pro-GRP and NSE to evaluate the efficacy of chemotherapy for SCLC patients has a higher sensitivity.

国家卫生部科技发展研究基金资助(No.W2012F2043)