肿瘤浸润淋巴细胞对直肠癌术前放疗预后的影响

Tumor-infiltrating lymphocytes predict efficacy of preoperative radiotherapy for rectal cancer

目的探讨直肠癌肿瘤组织内术前放疗后浸润淋巴细胞（TIL）数量改变对预后的影响。方法搜集近8年余接受30Gy分10次12d完成的术前放疗的直肠癌患者107例，分析TIL分级与术前放疗后病理消退程度及预后关系。结果直肠癌放疗前TIL1级75例，2级16例，3级16例，4级0例，术前放疗后TIL1级19例，2级43例，3级35例，4级10例。放疗后病理消退分级1级36例，2级57例，3级14例。单因素分析发现放疗前及放疗后TIL对局部病理消退影响有统计学意义（χ^2=36．80，P〈0．01；χ^2=14．00，P〈0．01）；术前放疗后癌巢内TIL及病理消退对预后影响显著（χ^2=24．00，P〈0．01；χ^2=12．17，P〈0．01）。Logistic多元分析提示放疗后TIL与病理消退关系密切（χ^2=8．05，P〈0．01）。结论放疗前及放疗后TIL与直肠癌术前放疗局部病理消退相关。直肠癌术前放疗后癌巢TIL是影响生存预后的因素之一。

Objective To evaluate the effect of tumor infiltrating lymphocyte（TIL） on prognosis of rectal cancer treated with preoperative radiotherapy. Methods From Jan. 1999 to Oct. 2007,107 patients with rectal cancer were treated with preoperative radiotherapy of 30 Gy/10f/12 days. The relationships among TIL, pathologic regression and prognosis were analyzed. Results Before radiotherapy, TIL in rectal cancer was 75 patients （70.1%） in grade 1,16 （ 15.0% ） in grade 2 and 16 （ 15.0% ） in grade 3 ;While after radiotherapy,it changed to 19 （17.7%） in grade 1,43 （40.2%） in grade 2,35 （32.7%） in grade 3 and 10 （ 9.3% ） in grade 4. After radiotherapy, pathologic regression was 36 （ 33.6% ） in grade 1,57 （53.3%） in grade 2 and 14 （ 13.1% ） in grade 3. Univariate analysis showed that TIL both before and after radiotherapy was the significant prognostic factor for local pathologic regression （ χ^2= 36.80, P 〈 0.01 ; χ^2=14.00 ,P 〈0.01 ）. Kaplan Meier survival analysis showed that TIL and pathologic regression after radiotherapy were significant associated with the snrvival（χ^2=24.00,P 〈0.01 ;χ^2=12.17,P 〈0.01 ）. Logistic regression showed that TIL after radiotherapy had a significant effect on local pathologic regression（ χ^2= 8.05, P 〈 0.01 ）. Condusions For rectal cancer treated with preoperative radiotherapy, TIL before and after radiotherapy is significantly related with local pathologic regression, and TIL after radiotherapy is a prognostic factor.