循环肿瘤细胞(circulating tumor cell, CTC)是指由原发灶脱落,侵入血液循环的肿瘤细胞。CTC能逃避机体免疫,在原发或远处脏器驻留,从而形成复发、转移病灶。原发肿瘤生长到一定阶段,会侵袭周围血管,肿瘤细胞会首先通过整联蛋白附着在血管基底膜处生长;当肿瘤细胞数量逐渐增多,其分泌的基质金属蛋白酶也逐渐增加,通过逐步消化掉IV型胶原蛋白,突破基底膜屏障,进入血液,即被称为CTC;CTC进入血液后,会随着血液循环游走全身,形成复发转移,不同肿瘤的远处转移与血流分布有很大关系。例如乳腺癌一般会在肺部有继发性病灶,而结肠癌则常形成肝转移。
循环肿瘤细胞是近30年来研究应用的仅有的几个新型肿瘤分子标志物之一。通过检测CTC数量和蛋白表达可对肿瘤进行确诊、判断预后、监控疗效。例如,当CTC出现上皮间质转换(EMT)、过表达上皮细胞粘附分子往往提示肿瘤患者预后不佳;通过对比手术或放化疗前后血液中CTC数量,可以判断治疗是否有效,具有重要的临床研究及应用价值。
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