直肠癌患者肿瘤原位免疫与外周血T淋巴细胞亚群及肿瘤分化程度的相关性

目的研究直肠癌患者肿瘤微环境中T淋巴细胞的表达情况,探讨肿瘤原位免疫与机体整体免疫状况及肿瘤分化程度的相关性。方法选取临床确诊的直肠癌患者20例,采用流式细胞仪检测患者术前和术后3、7 d外周静脉血中CD3＋、CD4＋、CD8＋T细胞亚群表达情况和CD4＋/CD8＋比值;免疫组化法检测患者手术标本中的肿瘤、癌旁和正常肠壁组织中CD3＋、CD8＋T细胞浸润情况;分析肿瘤原位免疫与外周血T细胞免疫的相关性,探讨肿瘤微环境中细胞免疫与肿瘤分化程度的关系。结果患者外周血中CD3＋、CD4＋T细胞亚群均显著低于对照组（均P〈0.01）,CD8＋T细胞亚群水平则明显高于对照组（P〈0.05）,且基本稳定。CD3＋、CD4＋T细胞亚群及CD4＋/CD8＋比值在术后3 d时均明显下降（均P〈0.05）,术后7 d时基本恢复术前水平。直肠癌组织内CD3＋、CD8＋细胞所占比例均明显高于癌旁和正常组织（均P〈0.05）。肿瘤组织中CD3＋、CD8＋细胞浸润比例与患者术前和术后7 d外周血CD3＋、CD8＋T细胞亚群水平成正相关（P〈0.05）。肿瘤分化程度不同的患者间CD3＋、CD8＋细胞浸润水平差异均无统计学意义（均P〉0.05）。结论直肠癌组织内的CD3＋和CD8＋T淋巴细胞有免疫监视、控制微小转移灶和术后残留肿瘤的发展、改善患者预后的作用。外周血T淋巴细胞状况可间接评判患者的预后。

The Correlation Between in Situ Immune Reaction and Peripheral T Lymphocyte Subsets as Well as Tumor Differentiation in Human Rectal Cancer

Objective To investigate T-lymphocyte expression in the tumor microenvironment in patients with rectal cancer and explore correlation between in situ immune reaction and immune as a whole as well as tumor differentiation.Methods Twenty clinical definite rectal cancer patients were chosen as the study target.The rectal cancer patients＇ peripheral venous blood and cancer specimens,paracancerous specimens and normal bowel wall tissue were collected before operation,3 days after operation and 7 days after operation in 20 patients with rectal cancer which had been confirmed in diagnosis.CD3＋,CD4＋,CD8＋ T-lymphocyte subsets and CD4＋/CD8＋ ratios were measured by flow cytometry（FCM）,and the amount of CD3＋,CD8＋ T-lymphocyte infiltrating was detected with immunohistochemical analyses.Correlativity between the rectal cancer patients＇ tumor in situ immune condition and peripheral T-lymphocyte immune state was analyzed.Correlation between the tumor immune and the tumor differentiation was also investigated.Results In peripheral venous blood in patients with rectal cancer in the perioperative pe-riod,CD3＋,CD4＋ T-lymphocyte subsets were significant lower than those in the control group（P0.01）,and CD8＋ T-lymphocyte subset was a little higher than that in the control group（P0.05）but was stable,CD3＋,CD4＋ T-lymphocyte subsets and CD4＋/CD8＋ ratios all had a decreased process in the first three days after the operation（P0.05）,and went back to the preoperative level in the 7th day.There were a great numble of CD3＋,CD8＋ T-lymphocyte aggregating around the cancer nest and infiltrating into the cancer cells in cancer specimens,significant more than paracancerous specimens and the normal tissue（P0.05）.The amount of CD3＋,CD8＋ T-lymphocyte infiltrating in the CT tissue of the rectal cancer patients and the CD3＋,CD8＋ T-lymphocyte subsets level in their peripheral venous blood had positive correlativity both before the operation and in the 7th day after the operation.The CD3＋,CD8＋ T-lymphocyte infiltrating condition in each tumor differentiation group of the rectal cancer patients had no significant deviation neither in CT tissue nor in IM ones.Conclusion A large number of CD3＋ and CD8＋ T-lymphocyte infiltration play an important role in the immunological surveillance of rectal cancer.At the same time,the local immune cells may activate the general immunity to control the micrometastasis and improve the prognosis of the patients.Peripheral T-lymphocyte immune state can be measured to reflect and monitor the strength of the tumor immune in situ indirectly.