目的 探讨新辅助化疗(neoadjuvant chemotherapy ,NAC)联合手术对局部晚期食管癌循环肿瘤细胞及生存率的影响。方法 选取2010-08至2015-08在医院接受治疗的局部晚期食管癌110 例,随机分为观察组和对照组,每组55例。观察组于术前给予NAC后行手术治疗,对照组单纯行手术治疗。采用免疫富集法和免疫荧光染色技术鉴别分离外周血中循环肿瘤细胞(circulating tumor cells ,CTC),分别于治疗前和治疗后3、6、12、24、36个月检测CTC值。随访3年并记录两组的近期生存率。结果 治疗前两组患者外周血中的CTC值差异无统计学意义。治疗后1、2、3年内,观察组外周血中的CTC值分别为6.88、6.56、7.20;对照组为12.8、13.0、13.2,观察组显著低于对照组,差异有统计学意义(P<0.05)。观察组术后1、2、3年生存率分别为96.36%、89.09%、65.45%;明显高于对照组的78.18%,56.36%,34.55%,差异有统计学意义(P<0.05)。结论 NAC联合手术可提高局部晚期食管癌患者的近期疗效、降低肿瘤恶性程度,提高患者近期生存率。

Objective To investigate the effect of neoadjuvant chemotherapy combined with surgery on circulating tumor cells and survival rate of local advanced esophageal cancer.Methods Between June 2010 and June 2015, 110 patients with locally advanced esophageal cancer treated in our hospital were randomized into the observation group and control group. Patients in the observation group were treated with neoadjuvant chemotherapy before operation, while those in the control group were treated surgically alone. The postoperative survival rate of the two groups was compared. At the same time, immunoenrichment and immunofluorescence staining were used to identify and isolate the circulating tumor cells (CTCs) in the peripheral blood. The levels of CTCs in peripheral blood were detected before and after treatment. All patients were followed up for 3 years and the short-term survival rates of the two groups were recorded.Results There was no significant difference in the levels of CTCs between the two groups before treatment. In the first, second, and third years after treatment, the CTC values in the peripheral blood of the observation group were 6.88, 6.56 and 7.20, respectively, compared with 12.8, 13.0 and 13.2 respectively in the control group. The levels of CTCs of the observation group were significantly lower than those of the control group (P<0.05). The 1 -, 2 -, and 3 - year survival rates in the observation group were 96.36%, 89.09% and 65.45%, respectively, compared with 78.18%, 56.36% and 34.55% respectively in the control group.Conclusions Neoadjuvant chemotherapy combined with surgery can reduce the malignancy of local advanced esophageal cancer, and improve the short-term efficacy as well as the survival rate of patients.