外周血免疫指标对肾癌术前诊断与分期的临床意义

Clinical significance of peripheral blood immune indexes in guiding renal cell carcinoma diagnosis and staging

目的:探讨外周血免疫指标对肾脏占位良恶性及肾癌术前临床分期判断的临床意义。方法:回顾性分析77例术前影像学检查诊断为肾脏占位患者的临床资料。44例患者术后病理或活检病理诊断为肾癌(RCC组),33例诊断为肾脏良性占位(对照组)。肾癌患者根据AJCC肾癌分期分为2亚组:局限性肾癌组(Ⅰ期)34例,进展性或转移性肾癌组10例(Ⅲ期5例,Ⅳ期5例)。研究外周血常见免疫指标,包括血常规、C反应蛋白(CRP)、T淋巴细胞亚群以及炎性因子等在各组间的差异。结果:血常规白细胞计数、CRP、中性粒细胞百分比、淋巴细胞百分比、单核细胞百分比和白细胞介素-2受体(IL-2R)在肾癌组及对照组间存在显著差异(P<0.05),而T淋巴细胞亚群及其他炎性因子[IL-8、IL-1B、IL-6、IL-10、肿瘤坏死因子α(TNF-α)]在两组间的差异无统计学意义(P<0.05)。此外,与局限性肾癌或对照组患者相比,进展性肾癌或转移性肾癌组患者外周血IL-8、IL-6、IL-10、IL-2R明显升高,表明机体免疫反应为以辅助型T细胞2(Th2)状态为主,机体处于免疫抑制状态。结论:外周血炎性因子水平与肾癌病理分期密切相关。然而外周血T淋巴细胞亚群对肾占位良恶性及肾癌术前临床分期判断的意义仍需进一步研究。

Objective:To investigate the clinical significance of peripheral blood immune indexes,especial T lymphocyte subsets and inflammatory factors,in guiding renal cell carcinoma(RCC) diagnosis and staging.Methods:Seventy-seven patients diagnosed with renal mass by imageological examinations were retrospectively analyzed.Forty-four cases were RCC and another 33 were confirmed as benign renal mass(control group) by post-resection pathological examination or biopsy.According to the AJCC RCC staging standard,all the RCC patients were ulteriorly divided into 2 groups:localized RCC(stage Ⅰ,34 cases),advanced or metastatic RCC(stage Ⅲ and Ⅳ,5 cases each).Detailed clinical data of blood routine,CRP,T lymphocyte subsets and inflammatory factors were collected and analyzed.Results:Statistical significance(P0.05) in leukocyte count,C-reactive protein(CRP),neutrophilic granulocyte percentage,lymphocyte percentage,monocyte percentage and interleukin-2 receptor(IL-2R) were observed between RCC group and control group.However,no significant differences(P0.05) in T lymphocyte subsets or other inflammatory factors,except for IL-2R,were shown between these 2 groups.Furthermore subgroup analysis indicated that patients with advanced or metastatic RCC presented higher levels of IL-8,IL-6,IL-10,IL-2R when compared to patients with localized RCC or benign renal masses.Conclusion:Peripheral blood inflammatory factors,especial IL-8,IL-6,IL-10,IL-2R,were closely associated with RCC pathological staging.However,the clinical significance of T lymphocyte subsets was still unknown.Further clinical researches with large scale are eagerly needed.