机构地区:[1]四川省岳池县人民医院妇产科,广安638300 [2]四川大学华西广安医院产科,广安638000
出 处:《国际肿瘤学杂志》2025年第4期224-230,共7页Journal of International Oncology
摘 要:目的探究国际妇产科联盟(FIGO)分期(2014)Ⅰ、Ⅱ期宫颈癌患者术后T细胞亚群变化特征及与术后淋巴结转移的关系。方法选择2018年11月至2020年11月于四川省岳池县人民医院和四川大学华西广安医院接受宫颈癌根治术及盆腔淋巴结清扫术治疗的FIGO分期为ⅠA、ⅠB1、ⅠB2、ⅡA1期的192例宫颈癌患者进行研究,根据FIGO分期的不同将患者分为Ⅰ期组(n=85)和Ⅱ期组(n=107);比较不同FIGO分期患者手术前、后T细胞亚群动态变化;采用重复测量方差分析不同分期患者治疗期间T细胞亚群水平;采用logistic回归分析宫颈癌患者术后淋巴结转移的影响因素;采用多因素logistic回归分析患者T细胞亚群与术后淋巴结转移的关系;采用受试者操作特征(ROC)曲线分析T细胞水平对患者术后淋巴结转移的预测效能。结果Ⅱ期患者术后淋巴结转移率[32.71%(35/107)]高于Ⅰ期患者[14.12%(12/85)],差异具有统计学意义(χ^(2)=8.86,P=0.003)。与Ⅱ期组相比,术前1 dⅠ期组患者的CD3^(+)、CD4^(+)T细胞水平和CD4^(+)/CD8^(+)比值均明显更高(均P<0.001),CD8^(+)T细胞水平明显更低(P<0.001)。术后不同阶段,患者CD3^(+)、CD4^(+)、CD8^(+)T细胞水平和CD4^(+)/CD8^(+)比值呈动态变化,术后1、7、30 d时,Ⅰ期组患者的CD3^(+)、CD4^(+)T细胞水平和CD4^(+)/CD8^(+)比值均高于Ⅱ期组患者(均P<0.001),CD8^(+)T细胞水平均低于Ⅱ期组患者(均P<0.001)。两组患者T细胞亚群CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比值时间效应、组间效应、交互效应方面差异均具有统计学意义(均P<0.001)。单因素分析显示,病理类型(OR=1.85,95%CI为1.14~2.33,P=0.015)、分化程度(OR=1.93,95%CI为1.18~2.67,P=0.024)、肌层浸润深度(OR=2.08,95%CI为1.26~2.59,P=0.012)、肿瘤形态(OR=2.17,95%CI为1.57~2.63,P=0.009)、宫旁浸润(OR=1.95,95%CI为1.43~2.76,P=0.036)、淋巴血管间隙侵犯(OR=2.03,95%CI为1.28~2.57,P=0.021)均是FIGO分期Ⅰ期和Ⅱ期宫颈癌患Objective To investigate the changes of T lymphocyte subsets in patients with stageⅠandⅡcervical cancer after surgery and their relationship with postoperative lymph node metastasis according to the International Federation of Gynecology and Obstetrics(FIGO)stage(2014).Methods A total of 192 patients with FIGO stageⅠA,ⅠB1,ⅠB2 andⅡA1 who received radical cervical cancer resection and pelvic lymph node dissection in People's Hospital of Yuechi County of Sichuan Province and West China Guang'an Hospital of Sichuan University from November 2018 to November 2020 were selected for this study.According to FIGO stage,patients were divided into stageⅠgroup(n=85)and stageⅡgroup(n=107).The dynamic changes of T lymphocytes subsets in patients with different FIGO stages were compared before and after surgery.Repeated measurement of variance was used to analyze the levels of T lymphocytes subsets in patients of different stages during treatment.Logistic regression was used to analyze the influencing factors of postoperative lymph node metastasis in patients with cervical cancer.Multivariate logistic regression was used to analyze the relationship between T lymphocytes subsets and postoperative lymph node metastasis.Receiver operator characteristic(ROC)curve was used to analyze the predictive efficacy of T lymphocytes level in postoperative lymph node metastasis.Results The postoperative lymph node metastasis rate in stageⅡpatients[32.71%(35/107)]was higher than that in stageⅠpatients[14.12%(12/85)],with a statistically significant difference(χ^(2)=8.86,P=0.003).Compared with the stageⅡgroup,the levels of CD3^(+),CD4^(+)T lymphocytes and CD4^(+)/CD8^(+)ratio were significantly higher in the stageⅠgroup 1 day before surgery(all P<0.001),and the level of CD8^(+)T lymphocytes was significantly lower(P<0.001).The levels of CD3^(+),CD4^(+),CD8^(+)T lymphocytes and the ratio of CD4^(+)/CD8^(+)showed dynamic changes at different stages after surgery.On 1,7 and 30 days after surgery,the levels of CD3^(+),CD4^(+
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