PFC方案化疗对进展期胃癌患者外周血淋巴细胞表型的影响

目的探讨紫杉醇(paclitaxel)联合氟尿嘧啶(5-Fu)及顺铂(CDDP)的治疗方案(简称PFC方案)对进展期胃癌患者外周血淋巴细胞表型的影响.方法 47例经病理学或细胞学确诊的进展期胃癌患者,采用PFC方案化疗(紫杉醇50 mg/m2,静滴3 h, 第1,8,15天;5-Fu 750 mg/m2,用便携式微量输液泵持续静脉输注,第1～5天;CDDP 20 mg/m2,静滴,第1～5天;每4周重复).应用流式细胞仪检测CD3 、CD4 、CD8 、CD16 56 、CD19 细胞的百分率.结果进展期胃癌患者经PFC方案化疗后CD4 、CD4 /CD8 、CD16 56 较化疗前显著升高(P＜0.05);CD3 、CD8 、CD19 化疗前后差异无显著性(P＞0.05).结论 PFC方案化疗可改善进展期胃癌患者机体的免疫功能.     

508例恶性肿瘤患者外周血淋巴细胞亚群分析

目的 研究肿瘤患者外周血淋巴细胞亚群变化特点.方法 收集天津中医药大学第一附属医院肿瘤患者508例(肺癌256例,胃癌152例,乳腺癌100例),健康志愿者50例,采集入组人员外周血2 ml,应用BD流式细胞仪进行淋巴细胞亚群检测,所得数据采用SPSS 16.0软件进行统计分析.结果 淋巴细胞均数(比例)比较:肿瘤患者淋巴细胞数量降低,健康志愿者为5125 (34.2％)、乳腺癌为3642(24.3％)、胃癌为3178(21.2％)、肺癌为2895(19.3％),依次降低.淋巴细胞亚群总异常病例数分别为肺癌218例(85.2％)、胃癌133例(87.5％)、乳腺癌88例(88.0％);T细胞亚群异常病例数为肺癌83例(32.4％)、乳腺癌32例(32.0％)、胃癌44例(28.9％);CD4 +/CD8+异常病例数为肺癌185例(72.3％)、胃癌108例(71.1％)、乳腺癌84例(84.0％);自然杀伤细胞亚群异常病例数为肺癌32例(12.5％)、胃癌22例(14.5％)、乳腺癌16例(16.0％);B细胞亚群异常病例数肺癌38例(14.8％)、胃癌52例(34.2％)、乳腺癌12例(12.0％).与健康志愿者相比,肺癌患者CD19+％(12.8±5.0∶11.5±5.7,t=3.006,P=0.003)降低;胃癌患者CD4+％ (39.2 ±7.7∶35.3±7.6,t=2.315,P=0.023)降低,CD19+％ (12.8±5.0∶8.9±4.2,t=3.302,P=0.010)降低;乳腺癌患者CD8+％(24.0±8.1∶29.1 ±13.0,t=2.019,P=0.047)升高.结论 肿瘤患者淋巴细胞数量减少,淋巴细胞亚群异常率增高,不同肿瘤患者淋巴细胞亚群异常变化表现出不同的特点.     

肺癌患者淋巴细胞亚群在外周血中的表达及其与预后的关系

背景与目的肺癌是最常见的恶性肿瘤之一,本研究旨在探讨肺癌患者外周血中淋巴细胞亚群的表达及与预后的关系。方法采用流式细胞仪检测221例原发性肺癌首诊患者外周血淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+、CD19+、CD25+、CD44+及NK细胞所占比例,并与96例健康人的血标本对比,结合临床及随访资料进行统计分析。结果与健康对照组对比,肺癌患者淋巴细胞亚群8项指标中CD3+及CD8+明显低于健康对照组,CD4+/CD8+、CD19+、CD25+、CD44+及NK细胞明显高于健康对照组(P<0.05)。与非小细胞肺癌(non-small cell lung cancer,NSCLC)相比,小细胞肺癌(small cell lung cancer,SCLC)的CD8+明显升高而CD4+和CD4+/CD8+明显下降(P<0.05)。化疗后与化疗前相比CD3+明显上升,NK细胞、CD19+及CD44+明显下降(P<0.05),其中CD44+在化疗后表达不升高者有生存优势(P=0.021),而其余3项指标与患者预期生存无关。结论肺癌患者外周血淋巴细胞亚群普遍发生改变,CD44+在化疗后的改变可能与预后相关。     

紫杉醇联合顺铂化疗对非小细胞肺癌患者外周血淋巴细胞表型的影响

目的：探讨紫杉醇联合顺铂化疗对非小细胞肺癌（ｎｏｎ－ｓｍａｌｌ ｃｅｌｌ ｌｕｎｇ ｃａｎｃｅｒ,ＮＳＣＬＣ）患者机体免疫功能的影响。方法：４５例经病理学或细胞学确诊的ＮＳＣＬＣ患者,采用紫杉醇、顺铂联合化疗方案,应用流式细胞仪检测ＣＤ３、ＣＤ４、ＣＤ８、ＣＤ１６、ＣＤ１９、ＣＤ２５阳性细胞的百分率。结果：ＮＳＣＬＣ患者经紫杉醇联合顺铂化疗后ＣＤ４、ＣＤ４／ＣＤ８、ＣＤ１６、ＣＤ２５较化疗前显著升高（Ｐ〈０．０５）;ＣＤ８、ＣＤ１９、ＣＤ３化疗前后无显著变化（Ｐ〉０．０５）;化疗后ＣＤ４、ＣＤ４／ＣＤ８、ＣＤ１６、ＣＤ２５、ＣＤ８、ＣＤ１９、ＣＤ３与正常对照组无显著差异（Ｐ〉０．０５）;鳞癌、腺癌及大细胞癌３组间化疗前、化疗后各项指标之间无显著性差异（Ｐ〉０．０５）。结论：紫杉醇联合顺铂化疗可改善机体的免疫功能     

恶性血液病患者化疗前后淋巴细胞亚群测定及其意义

 目的 研究恶性血液病患者化疗前后淋巴细胞亚群的变化及其意义。方法 采用流式细胞术对21例急性淋巴细胞白血病（ALL）／非霍奇金淋巴瘤（NHL）患者和23例急性髓系白血病（AML）患者化疗前后淋巴细胞亚群（包括CD+4细胞、CD+8细胞、CD+4／CD+8比值、NK细胞）进行检测。结果 CR组白血病、淋巴瘤的CD+4／CD+8与NK细胞比例均明显高于初诊组和化疗后未缓解组白血病、淋巴瘤（P＜0.05）;CR组ALL／NHL的CD+4／CD+8明显低于CR组AML（P＜0.05）。结论 CD+4／CD+8与NK细胞比例可以作为判断恶性血液病患者病情严重程度和预后的指标,与AML相比,ALL／NHL的细胞免疫功能受损更为严重。     

Alterations in lymphocyte subsets in blood may predict resectability in carcinoma of cardia or oesophagus

Impaired immune responses in patients with carcinoma of cardia or oesophagus have previously been reported. However, we do not know whether resectability correlates with specific immunological variables. Immunological assessment was performed in 35 such cancer patients including measurement of total T cells (CD3⁺) and T cell subsets (CD4⁺ and CD8⁺), NK cells (CD16⁺) and B cells (CD19⁺) in blood. In vitro lymphocyte responses to phytohemagglutinin (PHA) separated from peripheral blood were quantitated. The numbers in peripheral blood of both total T cells (CD3³⁺) and B lymphocytes (CD19⁺) were significantly lower in the inoperable patients compared to resected patients (P < 0.01). The number of NK cells (CD16⁺) was, however, not significantly lower in the inoperable patients compared to the patients operated for cure. Lymphocyte responses to PHA in vitro were similar in resectable and non-resectable patients, but significantly lower in inoperable patients compared to the controls (P < 0.01). In conclusion, resectability in carcinoma of cardia or oesophagus is associated with changes in both T (CD3⁺) and B (CD19⁺) cell subsets.     

NK ACTIVITY OF LYMPHOCYTE SUBSETS AND THE EFFECTS OF LOW DOSE RADIATION

ＮＫＡＣＴＩＶＩＴＹＯＦＬＹＭＰＨＯＣＹＴＥＳＵＢＳＥＴＳＡＮＤＴＨＥＥＦＦＥＣＴＳＯＦＬＯＷＤＯＳＥＲＡＤＩＡＴＩＯＮＳｕＬｉａｏｙｕａｎ苏燎原ＴｉａｎＨａｉｌｉｎ田海林ＸｕＹｉｎｇｄｏｎｇ徐映东ＧｅｎｇＹｏｎｇｚｈｉ耿勇志Ｄｅｐａｒｔｍｅｎｔｏ...     

The relationship between lymphocyte subsets and clinico-pathological determinants of survival in patients with primary operable invasive ductal breast cancer

Background:

The importance of lymphocyte subtypes in determining outcome in primary operable ductal invasive breast cancer remains unclear. The aim of present study was to examine the relationship between tumour lymphocyte subsets infiltrate and standard clinico-pathological factors and survival in patients with primary operable invasive ductal breast cancer.

Methods:

The analysis of the inflammatory cell infiltrate, including lymphocyte subtypes, was undertaken using immunohistochemical techniques and visual quantitative and semi-quantitative techniques in 338 patients with ductal breast cancer.

Results:

The majority (91%) of patients had high grade inflammatory cell infiltrate. The median follow-up of the survivors was 164 months. During this period, 65 died of their cancer. On univariate analysis, tumour inflammatory cell infiltrate, macrophages infiltrate (P<0.05), lymphocytic infiltrate (P<0.001) and CD8+ T-lymphocytic infiltrate (P<0.01) were associated with improved cancer-specific survival, whereas neutrophil (P<0.05) and CD138+ B-lymphocytic infiltrate (P<0.001) were associated with poorer cancer-specific survival. On multivariate analysis, tumour lymphocytic infiltrate (P<0.001), macrophage infiltrate (P<0.05), CD8+ T-lymphocytic infiltrate (P<0.01) and CD138+ B-lymphocytic infiltrate (P<0.001) were independently associated with cancer survival. When the significant inflammatory cell types were included with tumour-based factors in multivariate analysis only tumour size (Hazard ratios (HR): 2.55, 95% confidence interval (CI): 1.53–4.27, P<0.001), Ki-67 index (HR: 2.08, 95% CI: 1.08–4.00, P<0.05), lymphovascular invasion (HR: 4.40, 95% CI: 2.07–9.35, P<0.001), macrophage infiltrate (HR: 0.49, 95% CI: 0.33–0.73, P<0.001), lymphocytic infiltrate (HR: 0.11, 95% CI: 0.05–0.23, P<0.001), CD8+ T-lymphocytic infiltrate (HR: 0.57, 95% CI: 0.38–0.87, P<0.001) and CD138+ B-lymphocytic infiltrate (HR: 2.86, 95% CI: 1.79–4.56, P<0.001) were independently associated with cancer survival.

Conclusion:

The majority of patients with invasive ductal breast cancer had high-grade inflammatory cell infiltrate. In these patients, inflammatory cells including macrophage and lymphocytic infiltrate, and subsets CD8+ T-lymphocytic infiltrate and CD138+ B-lymphocytic infiltrate had superior prognostic value, compared with hormone status and lymph node involvement in patients with primary operable invasive ductal breast cancer.     

中晚期肺癌患者手术前后T淋巴细胞亚群和TNF的变化及其意义

目的　探讨外科手术在中晚期肺癌免疫中的作用。方法　应用间接免疫荧光法、酶联免疫夹心法(ELISA)分别检测15例中晚期肺癌患者外周血T淋巴细胞亚群及血清肿瘤坏死因子(TNF)于手术前后的动态变化,并行统计学分析。结果　①中晚期肺癌患者术前外周血T淋巴细胞亚群明显异常,CD3及CD4/CD8均较正常人组明显降低,而CD8和血清TNF水平则较正常人组明显增高(P均<0.05)。②肺癌患者术后17天CD3及CD4/CD8较术前明显增高,CD8明显降低,而血清TNF水平则较术前明显降低(P均<0.05)。结论　①手术治疗能恢复中晚期肺癌患者的免疫平衡。②从免疫学角度分析,争取手术切除是治疗中晚期肺癌首先考虑的措施目的　探讨外科手术在中晚期肺癌免疫中的作用。方法　应用间接免疫荧光法、酶联免疫夹心法(ELISA)分别检测15例中晚期肺癌患者外周血T淋巴细胞亚群及血清肿瘤坏死因子(TNF)于手术前后的动态变化,并行统计学分析。结果　①中晚期肺癌患者术前外周血T淋巴细胞亚群明显异常,CD3及CD4/CD8均较正常人组明显降低,而CD8和血清TNF水平则较正常人组明显增高(P均<0.05)。②肺癌患者术后17天CD3及CD4/CD8较术前明显增高,CD8明显降低,而血清TNF水平则较术前明显降低(P均<0.05)。结论　①手术治疗能恢复中晚期肺癌患者的免疫平衡。②     

Defining patient outcomes in stage IV colorectal cancer: a prospective study with baseline stratification according to disease resectability status

Background:

Stage IV colorectal cancer encompasses a broad patient population in which both curative and palliative management strategies may be used. In a phase II study primarily designed to assess the efficacy of capecitabine and oxaliplatin, we were able to prospectively examine the outcomes of patients with stage IV colorectal cancer according to the baseline resectability status.

Methods:

At enrolment, patients were stratified into three subgroups according to the resectability of liver disease and treatment intent: palliative chemotherapy (subgroup A), conversion therapy (subgroup B) or neoadjuvant therapy (subgroup C). All patients received chemotherapy with capecitabine 2000 mg m^–2 on days 1–14 and oxaliplatin 130 mg m^–2 on day 1 repeated every 3 weeks. Imaging was repeated every four cycles where feasible liver resection was undertaken after four or eight cycles of chemotherapy.

Results:

Of 128 enrolled patients, 74, 22 and 32 were stratified into subgroups A, B and C, respectively. Attempt at curative liver resection was undertaken in 10 (45%) patients in subgroup B and 19 (59%) in subgroup C. The median overall survival was 14.6, 24.5 and 52.9 months in subgroups A, B and C, respectively. For patients in subgroups B and C who underwent an attempt at curative resection, 3-year progression-free survival was 10% in subgroup B and 37% for subgroup C.

Conclusions:

This prospective study shows the wide variation in outcome according to baseline resectability status and highlights the potential clinical value of a modified staging system to distinguish between these patient subgroups.     

Effects of radiofrequency ablation on lymphocyte subsets and type 1/type 2 T cell subpopulations in patients with hepatocellular carcinoma

Objective  

To evaluate whether radiofrequency ablation (RFA) might have an influence on immune status in hepatocellular carcinoma (HCC) patients.     

胃癌术前选择性动脉药物灌注治疗

目的通过观察和比较胃癌外科手术前选择性动脉药物灌注治疗与全身静脉化疗的不同效果,以探讨胃癌术前选择性动脉药物灌注治疗的临床疗效及意义.方法32例胃癌病人外科术前对相应胃动脉选择性造影并灌注化疗药物;对照组32例胃癌患者施以全身静脉化疗后进行手术治疗,比较两组患者的临床症状、术中所见及术后病理变化,以比较其疗效.结果32例病人介入治疗后,临床症状均有不同程度好转;术中所见及组织病理学检查,血清CEA浓度,与对照组相比均有明显好转(P＜0.05).结论胃癌术前选择性动脉药物灌注化疗是一种有效的辅助治疗方法.     

丝裂霉素联合吉西他滨对原发性肝癌患者外周血淋巴细胞亚群及NK细胞水平的影响

目的 探讨丝裂霉素联合吉西他滨对原发性肝癌患者外周血淋巴细胞亚群及NK细胞水平的影响.方法 选择原发性肝癌患者96例,按照分层随机分组法分为对照组(n=48)和试验组(n=48),对照组予以吉西他滨治疗,试验组予以丝裂霉素联合吉西他滨治疗,比较治疗后两组的淋巴细胞亚群及NK细胞水平、临床疗效、不良反应.结果 治疗后,两组患者的淋巴细胞亚群(CD4+、CD4+/CD8+)及NK细胞水平均升高,试验组高于对照组(P﹤0.05);试验组治疗有效率高于对照组(P﹤0.05);两组总不良反应发生率比较,差异无统计学意义(P﹥0.05).结论 对原发性肝癌患者行丝裂霉素联合吉西他滨治疗能够有效调节外周血淋巴细胞亚群及NK细胞水平,缓解免疫抑制状态.     

Radiotherapy in inoperable stage I lung cancer

In 38 cases of Stage I lung cancer, for which surgery was not indicated because of poor cardiopulmonary function or other reason, radical irradiation yielded excellent results. The five year survival rate was 42.1%, the 10-year survival rate 28.4% and the 15-year survival rate 17.1%. Postradiation complications which can be life-threatening, were acceptably low in incidence, and there was no radiation-related death. The results support the concept of radical irradiation being acceptable as a treatment modality for Stage I lung cancer if the patients concerned cannot have surgery because of poor cardiopulmonary function or some other reason.     

PD-1抑制剂派姆单抗对晚期非小细胞肺癌T淋巴细胞亚群及NK细胞的影响

目的 观察晚期非小细胞肺癌(NSCLC)患者使用PD-1抑制剂治疗前后T淋巴细胞亚群及自然杀伤(NK)细胞的变化及临床疗效.方法 收集广州现代医院2015年1月至2016年1月的晚期NSCLC患者23例,经化疗或靶向药物治疗失败后给予6周期的PD-1抑制剂治疗.采集患者治疗前后外周静脉血检测CD3+、CD4+、CD8+及NK细胞占外周血淋巴细胞的百分比.治疗后第2、4、6周期行胸部CT评价疗效.结果 与治疗前相比,治疗后CD3+百分比(69.56％ ±7.81％∶63.91％ ±6.43％,t=2.679,P=0.005)、CD4+百分比(39.01％ ±4.98％∶36.09％ ±4.77％;t=2.031,P=0.024)和CD4+/CD8+(1.82±0.48∶1.49±0.32;t =2.743,P=0.004)均有所升高,差异有统计学意义.与治疗前相比,治疗后CD8+百分比(24.08％ ±5.13％∶26.04％ ±6.44％;t=1.142,P=0.130)和NK细胞百分比(22.68％ ±9.56％∶21.45％ ±10.01％;t =0.426,P=0.337)变化不大,差异无统计学意义.完成PD-1抑制剂6个治疗周期时,NSCLC患者完全缓解3例、部分缓解10例、病情稳定8例、疾病进展2例.10例患者出现轻度困倦、口干、咳嗽、瘙痒、皮疹等不良反应,均可以耐受.结论 PD-1抑制剂可提高患者的细胞免疫功能,取得更为理想的近期疗效,且不良反应可接受,或许可为NSCLC患者的治疗带来新的希望.     

The role of biologics in stomach cancer

The role for systemic treatment in gastric cancer has become more evident over the past years. Perioperative chemotherapy increases the cure rates in localized stages. At the same time, palliative chemotherapy has shown to prolong survival and maintain the patients’ quality of life in advanced disease. Our comprehension of prognostic and predictive molecular factors in stomach cancer is growing continuously. In parallel, we are making progress in understanding potential targets and pathways for designing molecular therapies against gastric cancer. First promising results have been reported from phase I and phase II studies investigating biologically targeted therapies in advanced gastric cancer. Currently, large randomized trials investigating inhibitors directed against the epidermal growth factor (EGFR) receptor and Her2-neu, against the epithelial cell adhesion molecule (EpCAM) and against vascular endothelial growth factor (VEGF) are being carried out. However, results from these comparative large scale studies are needed before biologically targeted drugs can be used in the clinical routine.     

I期乳腺癌治疗失败的原因探讨

１９７３至１９８３年底，收治Ｉ期原发女性乳腺癌２５３例，均经手术治疗及病理证实，均随访１０年以上，术后生存不足１０年者５６例，其中死于其他疾病５例，余５１例治疗失败的原因全部血行转移。治疗失败率为２１．５％（５１／２４８）。影响Ｉ期乳腺癌治疗失败的因素为：病理类型、淋巴结转移状况及二期手术。与肿瘤大小、年龄、病程长短、月经状况及术式无关。     

头颈部鳞癌同步放化疗患者外周血淋巴细胞亚群变化的研究

目的:分析头颈部鳞癌患者放化综合治疗前、后细胞的免疫功能变化,探讨放化综合治疗对头颈部鳞癌患者免疫功能的影响。方法:应用FACS Calibur流式细胞仪对46例头颈部鳞癌患者外周血T淋巴细胞亚群进行检测,并将放射疗前、中、后检测结果进行比较。结果:头颈部鳞癌患者治疗前、中、后的CD3+、CD4+、CD8+、NK细胞无明显变化,B细胞、CD4+/CD8+比值在放射治疗前后明显变化(P<0.05,P<0.05)。结论:头颈部鳞癌患者治疗前后T、B细胞亚群的检测对判断患者的免疫功能及疗效有参考作用,在同步放化疗期间应用增强免疫治疗有积极意义。     

头颈部鳞癌同步放化疗患者外周血淋巴细胞亚群变化的研究

目的：分析头颈部鳞癌患者放化综合治疗前、后细胞的免疫功能变化,探讨放化综合治疗对头颈部鳞癌患者免疫功能的影响。方法：应用FACS Calibur流式细胞仪对46例头颈部鳞癌患者外周血T淋巴细胞亚群进行检测,并将放射疗前、中、后检测结果进行比较。结果：头颈部鳞癌患者治疗前、中、后的CD3＋、CD4＋、CD8＋、NK细胞无明显变化,B细胞、CD4＋/CD8＋比值在放射治疗前后明显变化（P〈0.05,P〈0.05）。结论：头颈部鳞癌患者治疗前后T、B细胞亚群的检测对判断患者的免疫功能及疗效有参考作用,在同步放化疗期间应用增强免疫治疗有积极意义。     

上海市区胃癌危险因素探讨

目的 探索上海市区胃癌的危险因素，为采取有效的预防措施提供科学依据。方法 采用全人群病例对照研究，共调查1999年4月～1999年10月期间诊断的30～74岁的上海市区新发胃癌病例311例(男性198例，女性113例)，对照1579例，获得环境暴露等资料。采用非条件logistic模型控制混杂因素计算各个因素的调整比值比(OR)和95％可信限(95％CI)。结果 男性中吸烟、热烫饮食、油炸面食、患病前精神压抑和自我调节能力差、慢性胃炎及一级亲属胃癌史等因素可增加患胃癌的危险性；女性胃癌则与腌制食品(尤其是腌制蔬菜)、油炸食品、酒精摄人、患病前精神压抑和自我调节能力差、溃疡病史、慢性胃炎史及一级亲属胃癌史等关系密切。新鲜蔬菜、水果，新鲜豆类，豆制品，植物油和蛋及蛋制品等对胃癌有保护作用。调整可能的混杂因素后，分析结果均达到显著水平。结论 上海市区胃癌近十年危险因素没有明显改变，吸烟、腌制食品和油炸食品、慢性胃炎史和胃癌家族史等可能是主要的危险因素，而多食新鲜蔬菜和水果、豆及豆制品等对胃癌有保护作用。