食管癌患者放疗前免疫状态与临床预后的相关性分析  

Pre-radiotherapy immunological state in patients with esophageal carcinoma and prognosis: a correlation analysis

作　　者：何健[1] 王杰军[1] 钱建新[1] 甘露[1] 张霞[1] 焦晓栋[1] 柳珂[1] 

机构地区：[1]第二军医大学长征医院肿瘤科,上海200003

出　　处：《第二军医大学学报》2012年第11期1223-1226,共4页Academic Journal of Second Military Medical University

摘　　要：目的观察放疗前食管癌患者的免疫应激状态,探讨其与食管癌患者临床病理特征及预后的关系。方法 91例经病理组织学确诊的食管癌患者均行放射治疗,使用流式细胞仪测定其治疗前外周血T淋巴细胞亚群及自然杀伤(NK)细胞比例,以健康体检人群为对照观察其变化。分析放疗前免疫应激状态与食管癌患者临床病理参数之间的关系;采用单因素分析(Kaplan-Meier)法和多因素分析(Cox比例风险模型)法研究食管癌患者预后的影响因素。结果食管癌患者放疗前外周血CD3+CD4+(Th)T细胞、CD8+CD28+T细胞及NK细胞的比例较正常对照组明显下降(P<0.05)。与临床病理特征的相关性分析提示:CD3+CD8+(Ts)T淋巴细胞亚群比例则与淋巴结转移相关,而NK细胞与TNM分期相关(P<0.05)。单因素生存分析显示:Th细胞比例或CD8+CD28+T淋巴细胞比例高的食管癌患者其总体生存率要好于低比例患者(P<0.05);Cox模型多元回归分析结果显示:外周血Th细胞比例是预测食管癌患者生存的独立预后因素。结论放疗前外周血Th细胞比例可能有助于判断食管癌患者临床预后。Objective To observe the pre-radiotherapy immunological state in patients with esophageal carcinoma,and to explore its association with the clinical pathological characters and prognosis.Methods Totally 91 patients with pathologically confirmed esophageal cancer received radiotherapy.The proportions of T-lymphocyte subsets and natural killer（NK） cells in the peripheral blood were detected by the flow cytometry before radiotherapy;healthy population was taken as control.The correlation of immunological stress state and clinical pathological parameters were further evaluated in the patients.Univariate analysis（Kaplan-Meier） and multivariable analysis（Cox proportional hazards regression analysis） were used for survival analysis.Results The proportions of CD3＋CD4＋（Th） T cells,CD8＋CD28＋ T cells and NK cells in pre-radiotherapy esophageal carcinoma patients were significantly lower than those in the healthy population（P〈0.05）.We also found that the proportion of CD3＋CD8＋（Ts） T-lymphocytes was positively correlated with lymph node metastasis（P〈0.05） and the proportion of NK cells was positively correlated with TNM stage（P〈0.05）.Univariate analysis showed that the patients with high proportions of Th or CD8＋CD28＋ T cells had a better survival（P〈0.05）.The multivariate analysis revealed that the proportion of Th cells before radiotherapy was an independent prognostic factor for patients with esophageal carcinoma.Conclusion The pre-radiotherapy proportion of Th cells in the peripheral blood is an independent prognostic factor for patients with esophageal carcinoma.

关 键 词：食管肿瘤 T淋巴细胞亚群 自然杀伤细胞 放射疗法 预后 

分 类 号：R735.1[医药卫生—肿瘤]