Ⅲ期宫颈癌患者外周血淋巴细胞计数与总生存率相关性研究

Correlation between peripheral blood lymphocyte count and overall survival rate in patients with stage Ⅲ cervical cancer

目的探索治疗前宫颈癌患外周血淋巴细胞绝对值与预后的关系。方法2014年6月至2016年8月在山西省肿瘤医院住院的126例Ⅲ期宫颈癌患者进行同步放化疗,测量放化疗前后外周血各型淋巴细胞计数,同时对所有患者进行随访,统计从确诊之后30个月总生存率。结果通过ROC曲线分析确定放化疗前后外周血各型淋巴细胞与患者30个月生存状态之间最佳临界点,随后进行Kaplan-Meier单因素生存分析,治疗前外周血淋巴细胞总数、T细胞总数、细胞毒性T细胞(Tc)绝对数值与患者30个月总生存率密切相关,Log-Rank整体生存率比较差异具有统计学意义(P<0.05),其他类型外周血淋巴细胞计数与总生存率差异无统计学意义。通过多因素COX比例风险回归:淋巴细胞:HR=0.068,P=0.795,95%CI(0.438,2.944);T细胞:HR=2.277,P=0.131,95%CI(0.891,4.650);Tc:HR=2.807,P=0.094,95%CI(0.072,5.710);辅助性T细胞(Th):HR=0.521,P=0.470,95%CI(0.308,1.722)。结论Ⅲ期宫颈癌患者治疗前外周血淋巴细胞总数、T细胞、Tc与患者预后相关,可以作为患者预后的参考因素,其中Tc可能是独立预后因素。

Objective To investigate the correlation between the absolute count of peripheral blood lymphocytes before treatment and prognosis in patients.Methods A total of 126 patients with stage III cervical cancer were treated with concurrent chemoradiotherapy in Shanxi Provincial Tumor Hospital between June 2014 and August 2016.The various types of peripheral blood lymphocyte counts were measured at baseline and after chemoradiotherapy.All patients were followed up and the overall survival rate at 30 month was calculated.Results The ROC curve analysis was used to determine the optimal cut-off point between the various types of peripheral blood lymphocyte countsat baseline and after radiotherapy and the patients′30-month survival status,and the Kaplan-Meier univariate survival analysis was subsequently performed.The total peripheral blood lymphocyte count,total T cell count,and absolute count of cytotoxic T cellsat baseline were closely related to the overall survival rate at 30 month.Log-Rank test showed that there was significantly difference in the overall survivalrate(P<0.05).There were no statistically significant differences in the counts of other types of peripheral blood lymphocytes and overall survival rate.Multivariate Cox proportional hazards regression indicated:lymphocyte:HR=0.068,P=0.795,95%CI(0.438,2.944);T cells:HR=2.277,P=0.131,95%CI(0.891,4.650);Cytotoxic T cells:HR=2.807,P=0.094,95%CI(0.072,5.710);Helper T cells:HR=0.521,P=0.470,95%CI(0.308,1.722).Conclusion The total peripheral blood lymphocyte count,T cells,and cytotoxic T cells in patients with stageⅢcervical cancer before treatment are related to the prognosis of the patients,and may be used as reference factors for the prognosis of patients.Among them,cytotoxic T cells may be an independent prognostic factor.