基于阳性淋巴结/原发灶体积比分型的上行型和下行型鼻咽癌的外周血淋巴细胞亚群比较及预后分析  

Peripheral Blood Lymphocyte Subsets and Prognosis of Ascending and Descending Nasopharyngeal Carcinoma Based on the GTV-N/GTV-T Ratio

作　　者：何姗珊 陈思皓 刘刈 王丹[1,2] 邵世龙 杨牧 张石川 He Shanshan;Chen Sihao;Liu Yi;Wang Dan;Shao Shilong;Yang Mu;Zhang Shichuan(Radiation Oncology Key Laboratory of Sichuan Province,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;College of Clinical Medicine,Southwest Medical University,Luzhou 646000,Sichuan,China;School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Center for Basic Research on Oncology,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省肿瘤临床医学研究中心,四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院放射肿瘤学四川省重点实验室,成都610041 [2]西南医科大学临床医学院,四川泸州646000 [3]电子科技大学医学院,成都610041 [4]四川省肿瘤临床医学研究中心,四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院肿瘤基础研究中心,成都610041

出　　处：《肿瘤预防与治疗》2023年第8期631-643,共13页Journal of Cancer Control And Treatment

基　　金：四川省科技计划项目(编号:2022YFSY0055);成都市科技局科技项目(编号:2021-YF05-02390-SN)。

摘　　要：目的:评估基于阳性淋巴结与原发肿瘤体积比的临床分型在Ⅲ~Ⅳa期鼻咽癌中的预后价值,并探讨宿主免疫背景与分型可能存在的关联。方法:纳入四川省肿瘤医院2017~2021年接受外周血淋巴细胞亚群定量检测的Ⅲ~Ⅳa期鼻咽癌患者164例。利用MIM靶区勾画系统记录治疗前颈部阳性淋巴结体积(gross tumor volume of neck lymph nodes,GTV-N)和原发肿瘤体积(gross tumor volume of primary tumor,GTV-T)及其比值(GTV-N to GTV-T ratio,NTR)。通过受试者工作特征(receiver operating characteristic,ROC)曲线获得NTR预测无局部复发生存(local recurrence-free survival,LRFS)和无远处转移生存(distant metastasis-free survival,DMFS)的临界值。多因素Cox比例风险回归模型分析LRFS和DMFS的影响因素。结果:相较于传统的TN分型,按NTR重新分型后,67名(40.85%)患者的分型发生了变化。NTR上行型(NTR<0.4)患者的局部复发风险显著高于非上行型(P=0.006),NTR下行型(NTR>2.0)患者远处转移风险显著高于非下行型(P=0.004)。TN分型组间LRFS和DMFS差异均无统计学意义(P>0.05)。NTR下行型患者CD3+CD4+T淋巴细胞的百分比和绝对值显著高于NTR上行型患者(P<0.05)。单因素分析显示,NTR分型、顺铂累积剂量与LRFS相关,NTR分型、N分期、CD3+CD8+T淋巴细胞百分比与DMFS相关。多因素分析显示,仅NTR分型是LRFS(P=0.017)和DMFS(P=0.008)的独立预后因素。结论:基于阳性淋巴结与原发灶肿瘤体积比的NTR分型预测Ⅲ~Ⅳa期鼻咽癌患者LRFS和DMFS的能力优于TN分型,是LRFS和DMFS的唯一独立预后因素。下行型鼻咽癌患者CD3+CD4+T淋巴细胞明显升高,但与预后无关。Objective:To evaluate the prognostic value of clinical classification based on the gross tumor volume of neck lymph nodes(GTV-N)to gross tumor volume of primary tumor(GTV-T)ratio(NTR)in stageⅢ~Ⅳa nasopharyngeal carcinoma(NPC),and explore the correlation between host immune background and clinical classification.Methods:A total of 164 patients with stageⅢ~Ⅳa NPC who underwent quantitative detection of peripheral blood lymphocyte subsets in Sichuan Cancer Hospital from 2017 to 2021 were included.GTV-N and GTV-T and NTR were recorded by MIM target delineation system before treatment.The cut-off values of NTR for local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)were obtained by receiver operating characteristic(ROC)curves.Multivariate Cox proportional hazards regression model was used to analyze the influencing factors of LRFS and DMFS.Results:The NTR classification differed from the TN classification for 67(40.85%)patients.According to NTR classification,patients were classified as ascending type(NTR<0.4),descending type(NTR>2.0)and mixed type(0.4≤NTR≤2.0).Patients in ascending type had a significantly higher risk of local recurrence than those in non-ascending type(P=0.006).Patients in descending type had worse DMFS than those in non-descending type(P=0.004).However,there were no significant differences in LRFS and DMFS between different TN groups(P<0.05).The proportion and absolute value of CD3+CD4+T cell subset(P>0.05)in descending NPC patients were significantly higher than those in ascending NPC patients.Univariate analysis showed that NTR classification and cumulative dose of cisplatin were associated with LRFS;NTR classification,N stage and CD3+CD8+T cell percentage were associated with DMFS.Multivariate analysis showed that only NTR classification was an independent prognostic factor for LRFS(P=0.017)and DMFS(P=0.008).Conclusion:NTR classification based on lymph mode/primary tumor volume ratio is superior to TN classification in predicting LRFS and DMFS in patients wi

关 键 词：鼻咽癌 肿瘤体积 临床分型 外周血淋巴细胞亚群 预后 

分 类 号：R739.63[医药卫生—肿瘤] R730.7[医药卫生—临床医学]