title: Circulating cell-free human telomerase reverse transcriptase mRNA in plasma and its potential diagnostic and prognostic value for gastric cancer.
abstract: BACKGROUND
  Our aims were to detect circulating cell-free human telomerase reverse transcriptase (hTERT) mRNA in the plasma of gastric cancer patients and evaluate its potential diagnostic and prognostic value.
  
  
  METHODS
  Real-time quantitative reverse transcription-polymerase chain reaction was employed to detect circulating cell-free hTERT mRNA from 118 gastric cancer patients, 40 chronic atrophic gastritis (CAG) patients, and 58 healthy controls.
  
  
  RESULTS
  Circulating cell-free hTERT mRNA was detected in all gastric cancer patients, 39 (97.5 %) CAG patients and 56 (96.6 %) healthy control individuals, respectively. However, it was higher in gastric cancer than in CAG and healthy controls (all at P < 0.05). Moreover, its high level was significantly correlated with clinical stages (P < 0.001) and lymph nodes metastasis (P < 0.001). There was no difference between circulating cell-free mRNA and other parameters. The area under the receiver operating characteristic (ROC) curve was 0.891, and the optimal cut-off point was 0.18, providing a sensitivity of 66 % and a specificity of 87 %. The ROC analysis showed that the diagnosis capability of circulating cell-free mRNA was statistically significantly higher than that of carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9), alone [CEA (0.656); CA19-9 (0.722)] or in combination (0.756). Kaplan-Meier analysis demonstrated a correlation between increased circulating cell-free hTERT mRNA and reduced disease-free survival (P < 0.001) and overall survival (P < 0.001). Cox analysis indicated that it was an independent prognostic factor for disease-free survival and overall survival.
  
  
  CONCLUSIONS
  We concluded that circulating cell-free hTERT mRNA might serve as a potential and useful noninvasive tumor marker for gastric cancer.
authors.affiliation: Department of Infectious Diseases, Henan Provincial People's Hospital, 7# Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Kang
authors.forename: Jiancheng
authors.initials: J
authors.lastname: Zhang
authors.forename: Peichun
authors.initials: P
authors.lastname: Sun
authors.forename: Jia
authors.initials: J
authors.lastname: Shang
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000378:metabolism; D011379:Prognosis; D012333:RNA, Messenger / Q000097:blood*; D013274:Stomach Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D019098:Telomerase / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; D012333:RNA, Messenger; D019098:Telomerase