中低位进展期直肠癌患者新辅助放化疗疗效与外周血T淋巴细胞变化的相关性研究  

Correlation between neoadjuvant radiotherapy and chemotherapy efficacy and changes in peripheral blood T lymphocytes in patients with advanced mid-to-low rectal cancer

作　　者：韩越俊[1] 杜金林[1] 钟志凤[1] 王建平[1] Han Yuejun;Du Jinlin;Zhong Zhifeng;Wang Jianping(Department of Colorectal and Anal Surgery,Jinhua Municipal Central Hospital,Jinhua,321000,Zhejiang Province,China)

机构地区：[1]金华市中心医院结直肠肛门外科,金华321000

出　　处：《中国基层医药》2022年第4期549-553,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省金华市科学技术研究计划项目(2016-3-006)。

摘　　要：目的探讨中低位进展期直肠癌患者新辅助放化疗疗效与外周血T淋巴细胞变化的相关性。方法选取金华市中心医院2019年1月至2020年12月收治的直肠癌患者106例为研究对象。于新辅助放化疗治疗前和手术治疗前7 d抽取空腹静脉血,采用流式细胞仪进行T淋巴细胞(CD3^(+)、CD4^(+)、CD8^(+)、CD45RA^(+)、CD45RO^(+))检测。采用受试者工作特征曲线(ROC曲线)进行最佳截点的确定,采用logistic回归分析肿瘤消退分级(Tumor regression grade,TRG)的影响因素。结果新辅助放化疗治疗后,CD3^(+)(401.86±138.65)、CD4^(+)(225.83±87.17)、CD8^(+)(155.84±71.19)细胞数值均较治疗前[(477.33±141.74)、(647.38±203.19)、(348.22±113.75)]显著下降(t=10.78、11.17、9.49,均P<0.05);CD3^(+)%、CD4^(+)%、CD8^(+)%、CD45RA^(+)%以及CD45RO^(+)%治疗前后比较差异均无统计学意义(均P>0.05);CD45RO^(+)%比值在治疗后显著升高,且比值越大,患者TRG等级就越小(P<0.05);ROC曲线分析显示CD45RO^(+)%比值的最佳截点为1.08,曲线下面积为0.774(P=0.029),敏感度为82.5%,特异度为69.6%;logistic回归分析显示CD45RO^(+)%比值与患者TRG分级有显著相关性(P<0.05)。结论直肠癌患者新辅助化疗前后外周血中T淋巴细胞亚群中CD45RO^(+)%比值与TGR有着密切关系,能够成为预测新辅助放化疗敏感性的指标之一,具备显著创新性和科学性,为临床实际工作提供了全新的思路。Objective To correlate neoadjuvant radiotherapy and chemotherapy efficacy with changes in peripheral blood T lymphocytes in patients with advanced mid-to-low rectal cancer.Methods A total of 106 patients with rectal cancer who received treatment in Jinhua Municipal Central Hospital from January 2019 to December 2020 were included in this study.Fasting venous blood was taken before neoadjuvant radiotherapy and chemotherapy and 7 days before surgery to measure the numbers of CD3^(+),CD4^(+),CD8^(+),CD45RA^(+)and CD45RO^(+)cells using flow cytometry.The optimal cut-off point was determined using the receiver operating curve.The influential factors of tumor regression grade were analyzed using logistic regression analysis.Results After neoadjuvant radiotherapy and chemotherapy,the numbers of CD3^(+),CD4^(+),CD8^(+)cells were(401.86±138.65),(225.83±87.17),and(155.84±71.19)respectively,which were significantly decreased compared with before neoadjuvant radiotherapy and chemotherapy[(477.33±141.74),(647.38±203.19),(348.22±113.75),t=10.78,11.17,9.49,all P<0.05].There were no significant differences in the percentages of CD3^(+),CD4^(+),CD8^(+),CD45RA^(+)and CD45RO^(+)cells between before and after treatment(all P>0.05).The percentage of CD45RO^(+)cells was significantly increased after neoadjuvant radiotherapy and chemotherapy.A higher percentage of CD45RO^(+)cells led to a lower tumor regression grade(P<0.05).The receiver operating characteristic curve showed that the optimal cut-off point of the percentage of CD45RO^(+)cells was 1.08.The area under the receiver operating characteristic curve was 0.774(P=0.029),with a sensitivity of 82.5%and specificity of 69.6%.The logistic regression analysis revealed that the percentage of CD45RO^(+)cells was significantly correlated with tumor regression grade(P<0.05).Conclusion The percentage of CD45RO^(+)cells in T lymphocyte subsets before and after neoadjuvant radiotherapy and chemotherapy is closely related to tumor regression grade.It can be used as an indicator to predi

关 键 词：直肠肿瘤 T淋巴细胞 放射疗法 化学疗法 肿瘤消退 预测 相关性 药物筛选试验 抗肿瘤 

分 类 号：R735.37[医药卫生—肿瘤]