外周血CD4^+T细胞水平及CD4^+/CD8^+比值对Ⅳ期非小细胞肺癌生存影响——Nomogram预测模型的构建

Effect of CD4^+T cells and CD4^+/CD8^+in peripheral blood on survival of patients with stageⅣnon-small cell lung cancer—Establishment of a Nomogram prediction model

目的探讨外周血CD4^+T细胞水平、CD4^+/CD8^+比值作为预测Ⅳ期非小细胞肺癌(NSCLC)放疗后生存指标的可能性,并构建Nomogram预测模型。方法回顾分析2011-2017年间经病理学确诊的初治682例NSCLC患者外周血疗前CD4^+T细胞、CD4^+/CD8^+比值水平对临床因素、生存的影响,并构建Nomogram预测模型。结合110例疗后免疫细胞水平变化验证预测预后的价值。计数结果采用t检验,Kaplan-Meier法计算生存率并log-rank检验和单因素分析,Cox模型多因素分析。结果单因素分析治疗前CD4^+>43.15%显著延长生存,多因素分析治疗前CD4^+>43.15%是延长生存的因素,并可构建Nomogram预测模型并验证与总生存有良好的相关性;CD4^+T细胞水平43.15%作为临界值均显示治疗前、治疗后、治疗前后高水平、联合CD4^+/CD8^+>1.65的生存延长。结论外周血治疗前CD4^+T细胞的基线水平是Ⅳ期NSCLC生存的预后因子,而外周血治疗前CD4^+/CD8^+比值预测预后的作用有限。

Objective To explore the possibility of CD4^+T cells and CD4^+/CD8^+ratio in peripheral blood to predict the survival of patients with stageⅣnon-small cell lung cancer(NSCLC),and to establish a Nomogram prediction model.Methods The influence of CD4^+T cells and CD4^+/CD8^+ratio on the clinical factors and survival of 682 patients pathologically diagnosed with stageⅣNSCLC with no history of cancer treatment was retrospectively analyzed and the Nomogram prediction model was established.Combined with the changes of immune cells levels in 110 patients after treatment,the prognostic and predictive values of CD4^+T cells and CD4^+/CD8^+ratio were verified.Countable data were analyzed by t-test.The survival rate was calculated by Kaplan-Meier method,log-rank test or univariate analysis.The multivariate analysis was performed by Cox regression model.Results Univariate analysis demonstrated that CD4^+>43.15%before treatment significantly prolonged the survival.By multivariate analysis of Cox regression model,CD4^+>43.15%was an independent prognostic factor to prolong survival for stageⅣNSCLC.The Nomogram model was established and verified that the predicted and actual overall survivals were highly consistent.Further analysis showed that 43.15%as the critical value of CD4^+T cell level significantly prolonged survival when CD4^+expressed at a high-level before treatment,after treatment,before and after treatment,or combined with CD4^+/CD8^+>1.65.Conclusions The baseline level of CD4^+T cells before treatment in peripheral blood is an independent prognostic factor for stageⅣNSCLC.The CD4^+/CD8^+ratio before treatment has limited value in predicting the prognosis.