舒尼替尼对晚期肾癌患者免疫功能的影响  

Effect of Sunitinib therapy on immune function of patients with advanced renal cell carcinoma

作　　者：鲜鹏[1] 李元[1] 周宏[1] 罗宏[1] 刘南[1] 戴君勇[1] 

机构地区：[1]重庆市肿瘤研究所泌尿外科,400030

出　　处：《中华外科杂志》2016年第10期741-745,共5页Chinese Journal of Surgery

基　　金：重庆市卫计委基金项目（2012-2-495）

摘　　要：目的 探讨舒尼替尼对晚期肾癌患者免疫功能的影响.方法 前瞻性收集2010年7月至2014年7月重庆市肿瘤研究所泌尿外科收治的拟接受舒尼替尼靶向药物治疗的晚期肾癌患者27例.男性19例,女性8例;年龄36～75岁,平均（58±7）岁.病理类型：肾透明细胞癌25例,乳头状肾细胞癌1例,Xpll.2易位性肾癌1例.根据NCCN推荐的MSKCC晚期肾癌预后评分：中低危者22例,高危者5例.收集血清标本并使用流式细胞仪检测患者服药前外周血中CD3＋T淋巴细胞、CD8＋T淋巴细胞、CD4＋T淋巴细胞、自然杀伤（NK）细胞、B淋巴细胞的数量,分别于服药后4、6、10周及病情进展时再次收集血清标本并检测外周血中CD3＋T淋巴细胞、CD8＋T淋巴细胞、CD4＋T淋巴细胞、NK细胞、B淋巴细胞数量.两组数据的比较采用配对t检验,多组资料的比较采用重复测量方差分析,组间两两比较采用LSD-t法.结果 患者服用舒尼替尼治疗1周期后,血清CD3＋T淋巴细胞、CD8＋T淋巴细胞、NK细胞、B淋巴细胞数量与服药前比明显上升（均值差值分别为212±22、163±18、59±12、13.8±1.4,P值均＜0.05）,治疗2周期后与治疗前相比亦明显上升（均值差值分别为362±43、299±28、91±19、28.1±3.9,P值均＜0.05）,治疗2周期后与治疗1周期后相比继续上升（均值差值分别为150±35、135±25、33±10、14.4±3.6,P值均＜0.05）;治疗后1个周期和2个周期时CD4 ＋/CD8＋均较治疗前有所下降（-0.31±0.03、-0.44±0.04,P值均＜0.05）.CD4＋T淋巴细胞数量在服药前、治疗1周期后、治疗2周期后变化无统计学意义（F =0.873,P＞0.05）.随访截至2015年6月,27例患者均获得随访.出现病情进展者10例,其NK细胞、CD3 ＋T淋巴细胞、CD4＋T淋巴细胞、CD8 ＋T淋巴细胞数量与治疗前相比均明显下降（t=2.39～5.769,P值均＜0.05）.结论 舒尼替尼对晚期肾癌患者免疫功能有影响,肾癌进展与患者免疫功能有�Objective To evaluate the effect of Sunitinib therapy on immune function of patient with advanced renal cell carcinoma.Methods A total of 27 patient with advanced renal cell carcinoma who received Sunitinib therapy in Chongqing Cancer Hospital from July 2010 to July 2014 were recruited in a prospective cohort study.Nineteen were male patients and 8 were female patients aged from 36 to 75 years with mean age of （58 ± 7）years.Twenty-five cases were renal clear cell carcinoma,the other two cases were papillary renal cell carcinoma and Xpl 1.2 translocation renal cell carcinoma.According to MSKCC terminal prognosis scoring recommend by NCCN：22 cases were in low risk,5 cases were in high risk.All the patient took Sunitinib 50 mg orally once daily for 4 weeks,followed-up by 2 weeks.Flow cytometry was used to detect the levels of CD3 ＋,CD8 ＋,CD4 ＋ T lymphocyte,NK cell and B lymphocyte in peripheral blood of patients before taking medicine.The levels of CD3 ＋,CD8 ＋,CD4 ＋ T lymphocyte,NK cell,B lymphocyte in peripheral blood were detected again after 4 weeks,6 weeks,10 weeks and the disease progression.Paired t-test was used to analyze the data comparison of two groups,mean comparison in groups was conducted with repeated measurements analysis of variance,and the pairwise comparison was performed with LSD-t method.Results The levels of CD3 ＋,CD8 ＋ T lymphocyte,NK cell,B lymphocyte were significantly increased after the therapy of Sunitinib for 1 cycle （I-J was 212 ± 22,163 ± 18,59 ± 12,13.8 ± 1.4,respectively,all P 〈0.05）.The levels of CD3 ＋,CD8 ＋ T lymphocyte,NK cell,B lymphocyte were significantly increased after the therapy of Sunitinib for 2 cycles （I-J was 362 ± 43,299 ± 28,91 ± 19,28.1 ± 3.9,respectively,all P 〈0.05）,while the level of C4 ＋ lymphocyte was decreased,but no significant difference （F =0.873,P 〉0.05）.CD4 ＋/CD8 ＋ was significantly decreased after the therapy of Sunitinib for 1 cycle,and it went on decreasing after the therapy of Sunitinib for 2 c

关 键 词：癌 肾细胞 免疫功能 舒尼替尼 

分 类 号：R737.11[医药卫生—肿瘤]