新辅助化疗对局部进展期乳腺癌患者T淋巴细胞亚群及NK细胞免疫功能的影响

目的:探讨局部进展期乳腺癌患者新辅助化疗前、后T淋巴细胞亚群及NK细胞免疫功能的变化。方法:采用流式细胞术检测54例局部进展期乳腺癌患者新辅助化疗前后的静脉血T淋巴细胞亚群及NK细胞免疫功能。美国癌症联合会(American Joint Commitree on Cancer,AJCC)肿瘤分期为Ⅱb期(仅T3N0M0)和Ⅲ期(不包括N3),静脉血于第1周期新辅助化疗治疗前及第3周期化疗后21日抽取,淋巴细胞亚群检测包括:T(CD3+,CD4+,CD8+),NK(CD56+,CD16+),经过3周期新辅助化疗CEF方案(表柔比星、环磷酰胺和5-氟尿嘧啶),根据新辅助化疗临床效果评价分为2组,化疗有效组38例(CR和PR),化疗无效组16例(SD和PD),并与正常体检健康者(40例)作比较。结果:乳腺癌患者治疗前CD4+、CD4+/CD8+明显低于对照组(P<0.01),NK细胞明显低于对照组(P<0.05),新辅助化疗后,有效组总CD3+、CD4+、CD4+/CD8+、NK细胞较治疗前均显著升高(P<0.05),CD8+降低(P<0.05);无效组CD3+、CD4+/CD8+及NK细胞较治疗前显著降低(P<0.05),而CD8+升高(P<0.05)。结论:局部进展期乳腺癌患者免疫功能低下,有效的辅助化疗能提高患者的免疫功能,定期监测免疫功能对指导临床治疗有意义。

T lymphocyte subsets immunity and NK cells in patients with locally advanced breast cancer submitted to neoadjuvant chemotherapy

Objective:To explore the functional changes of T lymphocyte subsets and NK cells before and after neoadjuvant chemotherapy(NCT) in patients with locally advanced breast cancer.Methods:T lymphocyte and NK cells were measured by flowcytometry in patients with locally advanced breast and in control groups before and after neoadjuvant chemotherapy.The patients AJCC staging was Ⅱb(only T3N0M0 included) and Ⅲ(N3 not included).The T lymphocyte subsets were: T cells(CD3+,CD4+,CD8+),NK cells(CD56+,CD16+),after 3 cycles of cyclophosphamide,epirubicin and 5-fluorouracil(CEF),38 patients showed a complete or partial response(response group).After 3 cycles 16 showed no response or tumor progression(non-response group).A control group of 40 healthy women was used for pretreatment analysis.Results:The function of T lymphocyte subsets were significantly lower in locally advanced breast cancer patients before and after NCT than those in control group(P<0.05).After the NCT,CD3+,CD4+,CD4+/CD8+ and NK cells were higher in response group than those in pretreatment samples(P<0.05),while CD8+cells were lower than those in pretreatment samples(P<0.05).CD3+,CD4+,CD4+/CD8+ and NK cells were lower in non-response group than those in pretreatment samples(P<0.05),while CD8+cells were higher than those in pretreatment samples(P<0.05).Conclusion:The immune function was low in the patients with locally advanced breast cancer.The immune function of the patients could be increased by effective NCT.It may be helpful in the clinical monitoring and treatment by detecting the immune function.