| 宋春洋,祝淑钗,沈文斌,等.临床Ⅲ期食管癌患者放疗前后免疫功能及外周血炎症指标对预后的影响分析[J].中华放射医学与防护杂志,2020,40(3):189-195.Song Chunyang,Zhu Shuchai,Shen Wenbin,et al.Analysis of the effects of immunity index and blood inflammatory markers pre- and post-radiotherapy on prognosis of clinical stage Ⅲ esophageal cancer patients[J].Chin J Radiol Med Prot,2020,40(3):189-195 |
| 临床Ⅲ期食管癌患者放疗前后免疫功能及外周血炎症指标对预后的影响分析 |
| Analysis of the effects of immunity index and blood inflammatory markers pre- and post-radiotherapy on prognosis of clinical stage Ⅲ esophageal cancer patients |
| 投稿时间：2019-08-05 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.03.006 |
| 中文关键词: 免疫系统 外周血炎症指标 放射治疗 食管癌 预后 |
| 英文关键词:Immune system Blood inflammatory markers Radiotherapy Esophageal cancer Prognosis |
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| 中文摘要: |
| 目的 探讨临床Ⅲ期食管癌患者放疗前后免疫功能指标及外周血炎症指标与预后的关系。方法 回顾性分析2010年5月至2012年4月河北医科大学第四医院接受根治性放疗的临床Ⅲ期（T4N1M0）食管癌患者84例，通过检测患者放疗前、后外周血T淋巴细胞亚群CD3、CD4、CD8、CD4/CD8、CD56免疫指标及外周血中性粒细胞与淋巴细胞比值（NLR），监测并随访观察其近期疗效、复发及死亡原因等。所有患者均采用调强放疗，处方剂量56~66 Gy，1.8~2.0 Gy/次，5次/周。检测放疗前后免疫指标变化并进行单因素和多因素预后分析。结果 84例患者1年、3年、5年总生存率分别为78.57%、34.52%、19.59%，中位生存时间22.60个月；1年、3年、5年无进展生存率分别为69.05%、27.38%、12.09%，中位无进展生存时间21.20个月。近期疗效评价：完全缓解（CR）11例，部分缓解（PR）41例，疾病稳定（SD）24例，疾病进展（PD）8例，客观缓解率为61.90%（52/84）。单因素预后分析：放疗前NLR水平、免疫指标放疗后CD3、CD4、CD4/CD8水平与总生存及无进展生存预后均显著相关（总生存：χ2=7.851、4.443、8.381、5.972，P<0.05；无进展生存：χ2=7.475、6.290、9.659、8.738，P<0.05）。多因素预后分析：放疗前NLR、放疗后CD4和CD4/CD8水平为影响患者总生存预后的独立因素（χ2=10.464、4.292、5.507，P<0.05）；放疗前NLR、放疗后CD4/CD8水平均为影响患者无进展生存的独立因素（χ2=10.835、8.548，P<0.05）。结论 放射治疗可影响食管癌患者的免疫功能，放疗前NLR水平及放疗后CD4/CD8水平是评估食管癌患者预后方面的重要指标。 |
| 英文摘要: |
| Objective To study the effects of immunity index and blood inflammatory markers pre- and post-radiotherapy on prognosis of esophageal cancer patients with clinical stage Ⅲ. Methods A total of 84 esophageal cancer patients with clinical stage Ⅲ (T\-4N\-1M\-0) in Fourth Hospital of Hebei Medical University were analyzed, from May 2010 to April 2012. Intensity-modulated radiotherapy was delivered with a dose of 56-66 Gy/1.8-2.0 Gy per fraction. Flow cytometry was used to analyze the distribution of T-lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) and natural killer cells (CD56) in the peripheral blood pre- and post-radiotherapy. Neutrophil-lymphocyte ratio (NLR) pre- and post-radiotherapy were also tested. The correlation of immunity index and blood inflammatory markers with prognosis was analyzed by univariate and multivariate analysis. Results For all patients, the 1-, 3- and 5-year overall survival (OS) rates were 78.57%, 34.52% and 19.59%, respectively. The median OS time was 22.60 months. The 1-, 3- and 5-year progression free survival (PFS) rates were 69.05%, 27.38% and 12.09%, respectively. The median PFS time was 21.20 months. The objective response rate was 61.90%, with 11 patients of complete remission (CR) and 41 patients of partial remission (PR). Univariate analysis revealed that NLR before radiotherapy, T-lymphocyte subsets (CD3,CD4 and CD4/CD8) after radiotherapy were significantly associated with OS and PFS (OS:χ2=7.851, 4.443, 8.381, 5.972,P<0.05, PFS:χ2=7.475, 6.290, 9.659, 8.738, P<0.05). Multivariate COX regression analysis showed that NLR before radiotherapy, T-lymphocyte subsets (CD4, CD4/CD8) after radiotherapy were independent prognostic factors for OS (χ2=10.464, 4.292, 5.507, P<0.05). The NLR before radiotherapy and CD4/CD8 after radiotherapy were independent prognostic factors for PFS (χ2=10.835, 8.545, P<0.05). Conclusions Radiotherapy may influence the immune function. NLR before radiotherapy and CD4/CD8 after radiotherapy are of great value in predicting the prognosis of esophageal cancer patients. |
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