摘要
目的 探索局部晚期鼻咽癌患者诱导化疗及同步放化疗前后,外周血中淋巴细胞和树突状细胞(DC)亚群的变化及其与临床预后的关系。方法 回顾性分析2016-12-05-2018-05-31于贵州医科大学附属肿瘤医院就诊的134例局部晚期鼻咽癌患者临床资料,所有患者均接受2~3个周期多西他赛+顺铂+氟尿嘧啶(TPF方案)诱导化疗联合铂类方案同步放化疗。诱导化疗前后及同步放化疗结束后1周内,流式细胞术检测外周血中淋巴细胞及DC亚群。治疗结束后2年内随访1次/3个月;3~5年随访1次/6个月,观察生存情况。采用Friedman M检验比较外周血中淋巴细胞亚群和DC亚群在治疗前、诱导化疗后及同步放化疗后的变化,采用ROC曲线确定相应指标的临界值,Kaplan-Meier法和Cox回归模型进行生存分析。结果 TPF方案诱导化疗后外周血中CD3+[60.29(51.76,67.49)vs 63.85(58.63,70.10)]、CD4+[32.31(25.97,38.26)vs 34.10(28.28,40.90)]、CD8+[20.64(16.26,27.48)vs 23.32(18.37,29.10)]、活化CD4+[1.36(0.90,2.61)vs 2.02(1.14,2.82)]、活化CD8+[0.77(0.38,2.11)vs 1.90(0.78,4.00)]、CD8^(+)CD28^(+)[12.08(9.16,15.01)vs 13.86(10.34,16.63)]和髓样树突状细胞[MDC;5.04(2.73,7.07)vs 6.06(4.26,9.28)]均较治疗前升高,均P<0.05。同步放化疗后外周血中CD3^(+)[60.29(51.76,67.49)vs 57.60(47.39,66.50)]、CD4+[32.31(25.97,38.26)vs 26.06(20.06,32.29)]、CD8^(+)CD28^(+)[12.08(9.16,15.01)vs 10.09(6.74,13.15)]、CD4^(+)/CD8^(+)[1.58(1.07,1.97)vs 1.22(0.82,1.71)]和CD4+CD25+[4.10(2.79,5.60)vs 3.15(1.49,5.37)]较治疗前降低,均P<0.05。Kaplan-Meier单因素分析显示,治疗前外周血中CD3^(+)、CD4^(+)、活化CD4^(+)、CD8^(+)CD28^(+)、CD4^(+)/CD8^(+)、CD3-CD16^(+)、浆细胞样树突状细胞(pDC)和MDC的水平与患者生存预后相关,P<0.05。Cox模型预后分析发现高水平CD4+(HR=0.39,95%CI:0.18~0.89,P=0.021)和pDC(HR=0.37,95%CI:0.15~0.90,P=0.030)是局部晚期鼻咽癌总生存期(OS)的良好独立影响因素。结论 TPF方案诱导化疗�
Objective To explore the changes of lymphocytes and dendritic cells(DC)subsets in peripheral blood of patients with locally advanced nasopharyngeal carcinoma before and after induction chemotherapy and concurrent radiotherapy and chemotherapy,as well as their relationship with clinical prognosis.Methods Clinical data of patients with 134patients with local advanced nasopharyngeal cancer at the Guizhou Medical University Affiliated Cancer Hospital of from 2016-12-05to 2018-05-31were retrospectively analyzed.All patients accept 2to 3cycles of Doxisca+Cisplatin+Fluoropromoline(TPF scheme)induced chemotherapy+platinum scheme combined with radiation chemotherapy.Before and after induction chemotherapy and 1week within concurrent radiation and chemotherapy,flow cytometry was used to detect lymphocytes and DC subgroups in peripheral blood.The follow-up was once in every 3months within 2years after the treatment;once in every 6months in 3to 5years.The survival was observed.The Friedman M test was used to compare lymphocytes and DC subgroups in peripheral blood before treatment,after induction chemotherapy,and after concurrent chemoradiotherapy.ROC curves were used to determine the critical values of corresponding indicators.The Kaplan-Meier method and the COX regression model were used for survival analysis.Results The levels of CD3^(+)[60.29(51.76,67.49)vs 63.85(58.63,70.10)],CD4^(+)[32.31(25.97,38.26)vs 34.10(28.28,40.90)],CD8^(+)[20.64(16.26,27.48)vs23.32(18.37,29.10)],activated CD4^(+)[1.36(0.90,2.61)vs 2.02(1.14,2.82)],activated CD8^(+)[0.77(0.38,2.11)vs1.90(0.78,4.00)],CD8^(+)CD28^(+)[12.08(9.16,15.01)vs 13.86(10.34,16.63)]and the myeloid dendritic cells[MDC;5.04(2.73,7.07)vs 6.06(4.26,9.28)]in peripheral blood increased after TPF induction chemotherapy(P<0.05).After concurrent radiotherapy and chemotherapy,the levels of CD3^(+)[60.29(51.76,67.49)vs 57.60(47.39,66.50)],CD4^(+)[32.31(25.97,38.26)vs 26.06(20.06,32.29)],CD8^(+)CD28^(+)[12.08(9.16,15.01)vs 10.09(6.74,13.15)],CD4^(+)/CD8^(+)[1.58(1.07,1.97)vs 1.22(0.82,
作者
龙金华
龙萃
金风
吴伟莉
王伟
熊伟
曾林梅
徐露
顾安琴
金仙槐
LONG Jinhua;LONG Cui;JIN Feng;WU Weili;WANG Wei;XIONG Wei;ZENG Linmei;XU Lu;GU Anqin;JIN Xianhuai(Department of Oncology,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou 550004,China;Guizhou Medical University Af filiated Cancer Hospital,Guiyang,Guizhou 550008,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2023年第22期1345-1351,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
国家自然科学基金(82060555)
贵州省科技计划[黔科合基(2019)1266]。
关键词
鼻咽癌
放化疗
淋巴细胞亚群
树突状细胞亚群
生存率
nasopharyngeal carcinoma
radiotherapy and chemotherapy
lymphocyte subsets
dendritic cell subsets
survival rate
