摘要
目的探讨CD8^(+)T淋巴细胞与Ⅲ期直肠癌手术后辅助性放化疗患者预后结局的关系。方法选取河北中石油中心医院2018年1月至2020年12月经病理学检查确诊的180例Ⅲ期直肠癌患者作为研究对象,所有患者均接受根治性手术治疗,术后接受辅助性放化疗,根据患者辅助性放化疗后1个月与手术前的CD8^(+)T淋巴细胞变化将其分为升高组(n=102)和降低组(n=78)。比较升高组和降低组患者CD8^(+)T淋巴细胞变化趋势及生存时间差异,并采用Cox比例风险模型分析CD8^(+)T淋巴细胞与生存组(n=120)和死亡组(n=60)患者预后的关系。结果术前、术后1个月,升高组和降低组患者CD8^(+)T淋巴细胞比较差异均无统计学意义(均P>0.05)。辅助性放化疗后1个月,升高组患者CD8^(+)T淋巴细胞显著高于降低组(P<0.05)。升高组患者3年生存率与降低组比较差异无统计学意义(P>0.05)。降低组患者总生存(overall survival,OS)时间显著长于升高组(P<0.05)。生存组患者TNM分期中ⅢA期占比、高分化+中分化占比及辅助性放化疗后CD3^(+)T淋巴细胞升高占比、CD4^(+)T淋巴细胞升高占比、CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞比值升高占比均显著高于死亡组(均P<0.05)。Cox比例风险模型分析显示,TNM分期ⅢB+ⅢC期、低分化均是直肠癌患者不良预后结局的独立危险因素(均P<0.05),辅助性放化疗后的CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞比值升高均有助于改善直肠癌患者的预后结局(均P<0.05)。结论大部分Ⅲ期直肠癌手术后辅助性放化疗会在一定程度上损伤患者的细胞免疫功能,免疫功能更加平衡的Ⅲ期直肠癌患者预后更好,其中CD8^(+)T淋巴细胞降低的患者3年生存率与升高的患者差异不明显,但OS时间更长。
Objective To investigate the relationship between CD8^(+)T lymphocytes and prognosis in patients with stageⅢrectal cancer after surgery.Method A total of 180 patients with stageⅢrectal cancer diagnosed by pathological examination in Hebei Petro China Central Hospital from January 2018 to December 2020 were selected as the study subjects.All patients received radical surgery and adjuvant chemoradiotherapy after surgery.According to the changes of CD8^(+)T lymphocytes 1 month after adjuvant chemoradiotherapy and before surgery,patients were divided into increased group(n=102)and decreased group(n=78).The change trend of CD8^(+)T lymphocytes and the difference of survival time were compared between the elevated group and the reduced group,and the relationship between CD8^(+)T lymphocytes and the prognosis of survival group(n=120)and death group(n=60)patients was analyzed by Cox proportional risk model.Result Before and 1 month after surgery,there was no significant difference in CD8^(+)T lymphocytes between the increased group and the decreased group(all P>0.05).One month after adjuvant chemoradiotherapy,CD8^(+)T lymphocytes in the increased group were significantly higher than those in the decreased group(P<0.05).There was no significant difference in 3-year survival rate between the increased group and the reduced group(P>0.05).The overall survival(OS)time in the decreased group was significantly longer than that in the increased group(P<0.05).The proportion ofⅢA stage,the proportion of highly differentiated+moderately differentiated,the proportion of CD3+T lymphocytes,the proportion of CD4+T lymphocytes increased,and the proportion of CD4+T lymphocytes/CD8^(+)T lymphocytes increased after adjuvant chemoradiotherapy in survival group were significantly higher than that those in death group(all P<0.05).Cox proportional risk model analysis showed that TNM stageⅢB+ⅢC and low different iation were independent risk factors for poor prognosis of rectal cancer patients(all P<0.05).The increase of CD3+T lymphocy
作者
左艳华
董久兴
陈越
王辉
武素宁
皮曼
Zuo Yanhua;Dong Jiuxing;Chen Yue;Wang Hui;Wu Suning;Pi Man(Department of Oncology,Hebei Petro China Central Hospital,Langfang 065000,Hebei,China)
出处
《肿瘤综合治疗电子杂志》
2024年第4期67-71,共5页
Journal of Multidisciplinary Cancer Management(Electronic Version)
基金
河北省廊坊市科学技术研究与发展计划项目(2021013038)。
