胆管癌外周血淋巴细胞计数与脾脏受照射剂量学关系研究  

Radiation-related lymphopenia associated with spleen irradiation dose during radiotherapy in patients with cholangiocarcinoma

作　　者：孙世昌[1,2] 张云 赵倩倩[4] 张爱平 刘波 岳金波 SUN Shi-chang;ZHANG Yun;ZHAO Qian-qian;ZHANG Ai-ping;LIU Bo;YUE Jin-bo(School of Medicine and Life Sciences ,University of J inan-Shandong Academy of Medical Sciences, Jinan 250022 ,P. R. China;Jining Tumor Hospital ,Jining 272100, P. R. China;Shandong Cancer Hospital Affiliated to Shandong University,Shandong Academy of Medical Sciences, J inan 250117, P. R. China;Department of Radiation Oncology , Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China)

机构地区：[1]济南大学.山东省医学科学院医学与生命科学学院,山东济南250022 [2]济宁肿瘤医院肿瘤一科,山东济宁272100 [3]山东大学附属山东省肿瘤医院放一科,山东省医学科学院,山东济南250117 [4]复旦大学附属中山医院放疗科,上海200032 [5]济宁肿瘤医院放射物理室,山东济宁272100 [6]山东大学附属山东省肿瘤医院内七科,山东省医学科学院,山东济南250117

出　　处：《中华肿瘤防治杂志》2018年第11期791-795,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81472813)

摘　　要：目的放射治疗诱导的外周血淋巴细胞减少可能会导致抗肿瘤免疫抑制,本研究旨在探讨胆管癌患者放疗期间外周血淋巴细胞计数下降程度与脾脏受照射剂量的相关性。方法收集2009-01-01-2016-07-31山东省肿瘤医院(60例)和济宁肿瘤医院(10例)接受放疗的70例胆管癌患者病例资料。患者在开始放疗前和放疗中每周检查血常规监测外周血淋巴细胞绝对值,并计算出最低值。脾脏剂量体积变量包括VxGy(Vx是脾脏接受≥x Gy放疗剂量的部分所占百分比)和脾脏平均剂量(mean spleen dose,MSD),两者数值从Pinancle计划系统计算。总结患者性别、年龄、分期、KPS评分、治疗方法、放疗剂量和放疗靶区体积等对外周血淋巴细胞计数影响情况,应用多元回归分析探讨脾脏的放射剂量体积变量与外周血淋巴细胞计数下降的相关性。结果外周血淋巴细胞计数在放疗期间会发生下降(P<0.001),外周血淋巴细胞计数绝对值的最低值与脾脏剂量学参数有关,但血液中其他血细胞与此无关。单因素分析显示,外周血淋巴细胞绝对值计数与脾脏的MSD(P=0.039)、V5(P=0.012)、V10(P=0.043)和V15(P=0.049)有关。多元线性回归模型显示,外周血淋巴细胞绝对计数最低值降低只与脾脏V5有关(P=0.009),而与患者的KPS评分、性别、年龄、Child-Pugh分级、总剂量和肿瘤分期无关。通过受试者工作特征(receiver operating characteristic,ROC)曲线分析发现,Min ALC预测1年总生存的最佳临界值为390个细胞/μL,引起外周血淋巴细胞绝对值最低值降低有关的脾脏MSD、V5、V10和V15的预测性临界值分别为5.28Gy(P<0.001)、21.90%(P<0.001)、16.23%(P=0.012)和13.18%,P=0.026。结论胆管癌患者放疗期间外周血淋巴细胞绝对值降低与脾脏受高剂量照射有显著相关性。放疗期间最大限度的减少脾脏受照射剂量可以更好地保护外周血淋巴细胞,以免发生潜在的免疫抑制。OBJECTIVE Radiotherapy（RT）-induced reduction of peripheral blood lymphocytes may lead to antitumor immunosuppression.This study was to investigate the correlation between peripheral blood lymphocyte and spleen irradiation dose in patients with cholangiocarcinoma during RT.METHODS Seventy patients were retrospectively collected from Jining Tumor Hospital（n=10）and Shandong Cancer Hospital（n=60）from 01-01-2009 to 07-31-2016.Absolute value of peripheral blood lymphocyte was weekly collected pre-radiotherapy and post-radiotherapy and the lower one was chosen as the Min ALC（minimum value of absolute counts for peripheral blood lymphocyte）.Spleen dose-volume variables including VxGy（Vx,the percentage fraction of organ volume receiving≥x Gy）and mean spleen dose（MSD）were both calculated from Eclipse Treatment Planning.The patient＇s gender,age,staging,KPS,treatment methods,radiotherapy dose and target volume were analyzed on the peripheral blood lymphocyte counts.Multivariate regression analysis was performed to evaluate the correlation between spleen dose-volume variables and the induction of Min ALC.RESULTS Peripheral blood lymphocyte counts were decreased during radiotherapy（P〈0.001）.Only Min ALC was related to splenic dosimetry parameters significantly,rather than other blood cells.Univariate analysis revealed absolute peripheral blood lymphocyte counts were closely related to spleen MSD（P=0.039）,V5（P=0.012）,V10（P=0.043）and V15（P=0.049）.Multiple linear regression model showed that only spleen V5 Gy were correlated with the decline of Min ALC（P=0.009）,however,no correlation was found between the decline of Min ALC with the patient＇s KPS score,sex,age,Child-Pugh grade,total dose and tumor stage.According to the ROC curve,it was found that the optimal cutoff value of Min ALC to predict one year overall survival was 390 cells/μL.The cut-off values for predicting inhibition of Min ALC were spleen5.28 Gy（MSD,P〈0.001）,21.90%（V5,P〈0.001）,16.23%（V10,P=0.012�

关 键 词：胆管癌 放射治疗 淋巴细胞 脾剂量学 

分 类 号：R739.6[医药卫生—肿瘤]