直肠癌浸润T淋巴细胞密度预测放化疗敏感性的临床意义  

Clinical value of tumor-infiltrating T cell density in predicting sensitivity to chemoradiotherapy for rectal cancer

作　　者：肖斌毅 彭健宏[1] 林俊忠[1] 许静[1] 张荣欣[1] 方淯靖[1] 王永春 李聪[1] 万德森[1] 潘志忠[1] 伍小军[1] 

机构地区：[1]中山大学肿瘤防治中心结直肠科华南肿瘤学国家重点实验室肿瘤医学协同创新中心,广东广州510060

出　　处：《广东医学》2017年第22期3422-3425,共4页Guangdong Medical Journal

基　　金：广东省科技计划项目(编号:2013B021800146);中山大学临床医学研究5010计划项目(编号:2014010)

摘　　要：目的探讨直肠癌活检标本中肿瘤浸润T淋巴细胞(TILs)的密度对术前放化疗疗效的预测价值。方法收集99例经新辅助放化疗的局部晚期直肠癌患者资料,调取活检标本进行CD3免疫组化染色,计算肿瘤组织中CD3+TILs的密度,根据CD3+TILs的密度中位数将患者分为高密度组与低密度组,分析两组CD3+TILs的密度与放化疗后肿瘤退缩程度及患者预后的关系。结果 CD3+TILs密度中位数为180个细胞/40倍镜,CD3+TILs高密度和低密度的患者分别有49例和50例。CD3+TILs高密度组与CD3+TILs低密度组相比更容易获得肿瘤明显退缩(TRG1和2)(63.3%vs 42.0%,P=0.034)。CD3+TILs的密度与肿瘤浸润深度(T)、淋巴结受累(N)、肿瘤分化和治疗前癌胚抗原水平未见显著相关性。中位随访38个月,CD3+TILs高密度组与低密度组的3年无病生存率和总生存率差异无统计学意义(P=0.369,P=0.732)。结论直肠癌浸润CD3+T淋巴细胞密度可作为预测放化疗肿瘤退缩的有效指标,但其预后预测价值尚需进一步探讨。Objective To investigate the clinical value of CD3 ＋ tumor - infiltrating T cells （TILs） in pre - treatment biopsy samples on predicting therapeutic response to neo - adjuvant chemoradiotherapy （nCRT） for rectal cancer. Methods Biopsy samples from 99 patients with loeall advanced rectal cancer, who received nCRT followed by curative surgery, were immunostained using CD3 antibody. Density of CD3 ＋ TILs was recorded as number of cells per tissue surface （under x40 microscope） and classified as ＂high density＂ or ＂low density＂ according to its median density. Corre- lations of CD3 ＋ TILs density with tumor regression and survival were analyzed. Results Median density of CD3 ＋ TILs was 180 cells per tissue surface. High and low densities of CD3 ＋ TILs were found in 49 and 50 cases, respectively. Density of CD3 ＋ TILs showed significant correlation with tumor regression （ TRG = 1 and 2 ） （ 63.3% vs. 42. 0% , P = 0. 034） , but not with T stage, N stage, tumor differentiation or pretreatment CEA level. After the median follow - up of 38 months, disease free survival （DFS） and overall survival （OS） of 3 years in the high -density group showed no signif- icant difference from those in the low - density group （P = 0. 369 and P = 0. 732）. Conclusion Density of CD3 ＋ TILs in pretreatment biopsy samples is predictive of therapeutic response to nCRT, but its prognostic value remains to be confirmed.

关 键 词：直肠癌 放化疗 肿瘤浸润T淋巴细胞 

分 类 号：R735.37[医药卫生—肿瘤]