血清免疫指标对腹腔镜下肾动脉阻断肾部分切除治疗cT1期肾癌患者预后的作用  

The role of serum immune markers in prognostication of patients with cT1 stage renal cancer undergoing laparoscopic renal artery blockade partial nephrectomy

作　　者：韩成贤 任航 施量 李静凯 陈汉轩 HAN Chengxian;REN Hang;SHI Liang;LI Jingkai;CHEN Hanxuan(Department of Urology,the First People's Hospital of Xianyang City,Xianyang 712000,China;Department of Oncology,the First People's Hospital of Xianyang City,Xianyang 712000,China)

机构地区：[1]咸阳市第一人民医院泌尿外科,咸阳712000 [2]咸阳市第一人民医院肿瘤科,咸阳712000

出　　处：《国际免疫学杂志》2024年第5期479-486,共8页International Journal of Immunology

基　　金：咸阳市重点研发计划项目(L2022ZDYFSF038)。

摘　　要：目的探讨血清免疫指标在腹腔镜下肾动脉阻断肾部分切除治疗cT1期肾癌患者中对预后的作用。方法选取2020年3月至2021年3月于咸阳市第一人民医院接受腹腔镜下肾动脉阻断肾部分切除的cT1期肾癌患者72例作为研究对象。依据术后1年的生存状况,将患者分为生存组(54例)和死亡组(18例)。检测两组患者术前后血清中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、干扰素-γ(interferon-γ,IFN-γ)、CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)比例,分析血清免疫指标与患者预后的关系。结果死亡组患者的肾动脉阻断时间高于生存组[min:(28.67±5.33)比(20.42±4.12),t=6.82,P<0.05],且死亡组患者的TNF-α、IFN-γ、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均低于生存组[pg/mL:(3.65±1.61)比(6.82±1.83),(5.23±1.06)比(6.90±1.65);%:(51.25±3.77)比(56.68±3.84),(30.41±2.69)比(35.23±2.91);(1.02±0.04)比(1.18±0.13),t值分别为6.55,4.02,5.22,6.20,5.12,P值均<0.05]。Cox多因素分析结果显示,肾动脉阻断时间、Fuhrman分级、TNF-α、IFN-γ、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)为腹腔镜下肾动脉阻断肾部分切除治疗cT1期肾癌患者无进展生存期和总生存期的独立影响因素(均P<0.05)。血清免疫指标联合预测患者发生预后不良的曲线下面积为0.965,灵敏度为88.90%,特异度为98.10%。结论血清免疫指标与cT1期肾癌患者术后预后密切相关,联合检测免疫指标对于预测患者术后的预后情况具有重要的临床应用价值。ObjectiveTo explore the role of serum immunological markers in the prognosis of patients with cT1 stage renal cancer undergoing laparoscopic renal artery blockade partial nephrectomy.MethodsA total of 72 patients with cT1 stage renal cancer who underwent laparoscopic renal artery blockade partial nephrectomy were selected at the First People's Hospital of Xianyang City from March 2020 to March 2021 was conducted.Based on the survival status one year postoperatively,patients were divided into a survival group(54 cases)and a death group(18 cases).Serum levels of tumor necrosis factor-alpha(TNF-α),interferon-gamma(IFN-γ),CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)ratio were measured before and after surgery,and their relationship with patient prognosis was analyzed.ResultsThe renal artery clamping time was longer in the death group compared to the survival group[min:(28.67±5.33)vs(20.42±4.12),t=6.82,P<0.05].Serum levels of TNF-α,IFN-γ,CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)were significantly lower in the death group[pg/mL:(3.65±1.61)vs(6.82±1.83),(5.23±1.06)vs(6.90±1.65);%:(51.25±3.77)vs(56.68±3.84),(30.41±2.69)vs(35.23±2.91);(1.02±0.04)vs(1.18±0.13),t values were 6.55,4.02,5.22,6.20,5.12,all P values<0.05].Cox multivariate analysis identified renal artery clamping time,Fuhrman grade,TNF-α,IFN-γ,CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)as independent predictors of progression-free survival(PFS)and overall survival(OS)in these patients(all P values<0.05).The combined predictive ability of these serum immune markers for adverse outcomes had an area under the curve(AUC)of 0.965,with a sensitivity of 88.9%and a specificity of 98.1%.ConclusionSerum immunological markers are closely related to the postoperative prognosis of patients with cT1 stage renal cancer.The combined measurement of these markers holds significant clinical value for predicting postoperative prognosis.

关 键 词：cT1期肾癌 腹腔镜肾部分切除术 免疫学指标 预后 

分 类 号：R737.11[医药卫生—肿瘤]