胃癌患者手术前后T淋巴细胞亚群的变化及预后分析

The changes of T lymphocyte subsets and prognosis in the gastric cancer patients undergoing surgical treatment

目的分析Ⅰ～Ⅲ期手术切除胃癌患者的临床特点,观察手术前后血液T淋巴细胞亚群的变化,探讨患者手术前后机体免疫反应对胃癌患者预后的影响,为建立胃癌术后的个体化治疗模式提供理论依据。方法对在解放军总医院2010年1月—2011年6月行手术治疗的Ⅰ～Ⅲ期胃癌患者41例进行研究,以流式细胞术检测胃癌患者手术前后外周血T淋巴细胞亚群的变化,并与健康人群相对照,结合临床病理特征及术后无病生存期(disease free survival,DFS)进行分析,探讨各项指标手术前后的变化与术后DFS的关系。结果对胃癌术后患者进行临床病理特点与DFS相关的单因素分析,发现年龄、症状、TNM分期、手术切缘与DFS相关;分析外周血T细胞CD3+、CD3+CD4+、CD4+/CD8+的表达,发现胃癌术前组低于健康对照组、胃癌术后组(P<0.05,P<0.01);CD3+CD8+的表达,胃癌术前组高于健康对照组和胃癌术后组(P<0.05,P<0.01);CD8+CD28+的表达,胃癌术前组低于健康对照组(P<0.05);CD4+CD25+的表达,胃癌术前组和术后组均高于健康对照组(P<0.01)。CD3+、CD3-CD16+CD56+低表达较高表达患者、CD3+CD8+高表达较低表达患者疾病复发转移风险分别为0.273、2.595、5.394倍。结论胃癌患者临床及病理特征与DFS相关;外周血T细胞CD3+CD4+低表达DFS生存率降低,术后CD3+、CD3-CD16+56+低表达,CD3+CD8+高表达患者复发转移风险高。

Objective To investigate clinical features of the stage Ⅰ-Ⅲ resected gastric cancer（GC）,toobserve the changes of T lymphocyte subsets perioperatively in GC patients,so as to explore the effect of organismimmune response on prognosis in GC,and offer theory basis for individualized treatment. Methods The 41 caseswith resected GC in PLA General Hospital from Jan. 2010 to Jun. 2011,which were diagnosed with stage Ⅰ-ⅢGC in 41 cases;the changes of T lymphocyte subsets in peripheral blood were detected perioperatively by flowcytometry and compared with healthy control group,so analyzed integrating clinical,pathology feature and DFSresected so that searched for the relationships of all marker changes perioperatively with disease free survival（DFS）. Results The clinical pathology characteristics were correlated to DFS shown by single factor analysis：ages,symptom,TNM Staging,and operation cutting edge. The expression of CD3 ＋ ,CD3 ＋CD4 ＋ ,CD4 ＋/CD8 ＋ ofpreoperative GC group in peripheral blood was lower than healthy control group and resected group （P〈0.05,P〈0.01）;the expression of CD3 ＋CD8 ＋ in preoperative GC group was higher than healthy control group,resectedgroup （P〈0.05,P〈0.01）;the expression of CD8＋CD28＋ in preoperative GC group was lower than healthy controlgroup （P〈0.05）;the expression of CD4＋CD25＋ was higher in preoperative and resected GC group than healthygroup （P〈0.01）,respectively. The risk of relapse and metastasis was 0.273,2.595,5.394 with the lower VS thehigher expression of CD3 ＋ ,CD3 -CD16 ＋56 ＋ ,the higher VS the lower expression of CD3 ＋CD8 ＋ ,respectively.Conclusion The clinical pathology characteristics are correlated to DFS;DFS is decreased with the lowerexpression of CD3＋CD4＋ in peripheral blood;the risk of relapse and metastasis is the lower expression of CD3＋,CD3-CD16＋56＋ and the higher expression of CD3＋CD8＋ in resected GC,respectively.