外周血T淋巴细胞亚群变化与直肠癌患者新辅助放化疗效果的关系

The changes of peripheral blood T lymphocyte subsets predict the effect of neoadjuvant chemoradiotherapy in rectal cancer

目的探讨中低位进展期直肠癌患者外周血T淋巴细胞亚群的变化与直肠癌新辅助放化疗的关系.方法选择2016年6月至2017年6月在首都医科大学附属北京朝阳医院普外科接受新辅助放化疗的108例直肠癌患者的临床病理资料.患者于新辅助治疗前1周和手术前1周抽取静脉血,采用流式细胞术检测T细胞亚群CD3^+、CD4^+、CD8^+、CD45RA^+、CD45RO^+的表达水平.采用ROC曲线分析确定淋巴细胞比值的最佳截点,Logistics回归分析肿瘤消退分级(TRG)的影响因素.结果经过新辅助治疗之后,患者外周血CD3^+、CD4^+、CD8^+T淋巴细胞数值较新辅助治疗前下降,差异均有统计学意义(均P<0.05);患者外周血CD4^+、CD8^+、CD45RA^+、CD45RO^+T淋巴细胞比值无下降,差异均无统计学意义(均P>0.05).新辅助治疗后患者外周血CD45RO升高越高的患者肿瘤TRG越小(P<0.05).ROC曲线分析确定外周血CD45RO在新辅助治疗前后的比值1.07为最佳截点.多因素分析显示外周血CD45RO的变化与患者的TRG显著相关(OR=26.867,95%CI:1.530~471.635,P=0.005).结论外周血CD45RO在直肠癌患者新辅助放化疗前后比值的水平可作为预测新辅助治疗敏感性的指标之一.

Objective To explore the ffect of peripheral blood T lymphoeyte subsets on locally advanced rectal cancer after neoadjuvant chemoradiotherapy.Methods 108 patients were included at the Department of General Surgery of Beijjing Chaoyang Hospital from Jun 2016 to Jun 2017.Peripheral blood was ollected within one week before neoadjuvant therapy and one week before rectal surgery.Flow cytometry was applied to deteet the CD3^+、CD4^+、CD8^+、CD45RA^+、CD45RO^+expression.Receiver operating characteristic(ROC)curve analysis was performed to determine the best cul-off value of the ratio of lymphocytes.A logistic regression model was obtained in multivariate analysis.Results The values of CD3^+,CD4^+and CD8^+T lymphocytes in peripheral blood of the patients decreased compared with that before neoadjuvant treatment(all P<0.05).There was no significant decrease in the proportion of CD4^+,CD8^+,CD45RA^+T and CD45RO^+lymphocytes in patients'peripheral blood(all P>0.05).The CD45RO in peripheral blood decreases during neoadjuvant therapy for locally advanced rectal cancer,and it is associated with better tumor regression(P<0.05).The best cut-off value for the ratio changes of CD45RO 1.07.The ratio changes of CD45RO were the only significant factor for tumor regression in multivariate analysis(P=0.005,OR=26.867,95%CI:1.530-471.635)。Conclusion The percentage of peripheral blouu CD45RO may predict the scusitirity uf evadjurant therapy in rectal caner patients.