CD8^+T细胞水平评价Ⅲ-Ⅳ期非小细胞肺癌放化疗预后价值  

Prognostic value of peripheral blood CD8^+T lymphocytes for stage Ⅲ-Ⅳ non-small cell lung cancer patients treated with chemoradiotherapy

作　　者：王豪杰 王李雪 欧阳伟炜 马筑 李青松 杨文刚 栗惠琴 苏胜发 卢冰 Wang Haojie;Wang Lixue;Ouyang Weiwei;Ma Zhu;Li Qingsong;Yang Wengang;Li Huiqin;Su Shengfa;Lu Bing(Department of Oncology,Affiliated Hospital of Guizhou Medical University,Guizhou Cancer Hospital,Teaching and Research Section of Oncology,Guiyang 550004,China)

机构地区：[1]贵州医科大学肿瘤学教研室贵州医科大学附属医院/贵州省肿瘤医院胸部肿瘤科,贵阳550004

出　　处：《中华放射肿瘤学杂志》2020年第10期849-854,共6页Chinese Journal of Radiation Oncology

摘　　要：目的探讨Ⅲ-Ⅳ期非小细胞肺癌(NSCLC)放化疗前后外周血CD+8T细胞水平及其变化规律预测生存的临床价值。方法收集2011-2017年完成外周血CD+8T细胞检测的Ⅲ-Ⅳ期NSCLC共795例(其中249例疗后6个月内完成1~3次检测),分析治疗前后CD+8T细胞不同水平的生存差异及其变化规律对生存的预测作用。Kaplan-Meier生存分析并log-rank检验和单因素预后分析,Cox模型多因素预后分析。结果795例患者不同临床因素的疗前外周血CD+8T细胞水平相近,Ⅲ期NSCLC中<26.44%生存期显著延长(P=0.043)。疗后CD+8T细胞水平较疗前显著升高且1~3个月内水平相似,4~6个月下降但仍然显著高于疗前。249例疗后CD+8T细胞<43.90%水平的中位生存期高于≥43.90%的(22个月∶16个月,P=0.032),但分层分析疗后1、2~3个月的生存期相近(P>0.05),而4~6个月显示生存期不同(P=0.001)。多因素分析显示疗后CD+8T细胞<43.90%是延长生存的独立预后因素(HR=0.714,P=0.031)。结论Ⅲ-Ⅳ期NSCLC外周血疗前CD+8T细胞预测预后作用有限,疗后CD+8T细胞显著升高;一定水平的升高可延长生存期,过度升高对生存不利;CD+8T细胞亚型检测更重要。Objective To explore the changes of CD+8 T cells in stageⅢ-Ⅳnon-small cell lung cancer(NSCLC)patients before and after radiochemotherapy and evaluate its clinical value in predicting survival.Methods A total of 795 patients with stageⅢ-ⅣNSCLC who completed CD+8 T cell testing from January 2011 to December 2017 were recruited(249 patients completed 1-3 tests within 6 months after treatment).The survival difference of patients with different levels of CD+8 T cells and the prognostic value of the changes in the CD+8 T cell level were analyzed.The survival analysis was performed by Kaplan-Meier method and log-rank test or univariate analysis.The multivariate survival analysis was conducted by Cox’s regression model.Results Before treatment,the levels of CD+8 T cells in the peripheral blood did not significantly differ among patients with different clinical factors.The survival time of stageⅢNSCLC patients with CD+8 T cell levels of<26.44%was significantly prolonged(P=0.043).After treatment,the levels of CD+8 T cells were significantly higher than those before treatment.The levels were similar within 1-3 months,decreased after 4-6 months but still significantly higher than those before treatment.The median survival time of patients with CD+8cell levels of<43.90%after treatment was 22 months,significantly longer than 16 months of those with CD+8cell levels of≥43.90%(P=0.032).Stratified analysis demonstrated no significant difference in the survival time at 1 month and 2-3 months after treatment(P>0.05),whereas the survival time significantly differed at 4-6 months(P=0.001).The multivariate survival analysis showed that CD+8 cell levels of<43.90%after treatment was an independent prognostic factor(HR=0.714,P=0.031).Conclusions The effect of CD+8 T cells on prognosis of patients with stageⅢ-ⅣNSCLC is limited.After treatment,CD+8 T cell levels are increased significantly.A certain increase in the CD+8 T cell levels can prolong the survival time.The detection of CD+8 T cell subtypes plays a more significa

关 键 词：癌 非小细胞肺/放化疗法 CD8^+T淋巴细胞 预后 

分 类 号：R734.2[医药卫生—肿瘤]