术前放化疗、放疗与单纯手术对中低位直肠癌患者免疫功能的影响

目的 探讨术前放化疗、放疗及单纯手术对中低位直肠癌患者细胞免疫功能的影响.方法 90例中低位直肠癌患者非随机同期分为术前放疗组、术前放化疗组、单纯手术组(对照组)3组,每组各有30例患者.术前放疗组采用常规分割放疗,三野照射总剂量30 Gy,照射次数10次,约2周.术前放化疗组的化疗采用口服卡培他滨的单药方案,每日1000 mg/m2,连用2周,休息1周,共2个疗程;放疗选择在口服化疗药两天后进行,方法同单纯放疗组.单纯手术组术前不接受放化疗.放化疗组和放疗组患者均于相关治疗结束3周后手术.分别于入院当天、手术前1 d、术后7 d及术后1个月抽取患者外周血,采用流式细胞术检测患者外周血中T细胞亚群百分率(CD3+、CD4+、CD8+、CD4+/CD8+)及NK细胞含量变化.结果 放疗前后,术前放疗组和术前放化疗组CD3+、CD4+、CD8+、CD4+/CD8+、NK细胞水平差异无统计学意义(P>0.05);3组患者手术后1周CD3+、CD4+、CD4+/CD8+、NK细胞水平均明显降低,CD8+升高(P<0.05),术后1个月CD3+、CD4+、CD4+/CD8+、NK细胞含量均明显升高,CD8+明显降低(P<0.05),但各组间在不同治疗时段内细胞免疫差异无统计学意义(P>0.05).结论 术前放化疗作为一种中低位直肠癌新的有效治疗方法,对患者的细胞免疫功能无明显影响.

Influence of preoperative chemoradiotherapy, preoperative chemotherapy, and operation on immunity function in middle or lower rectal cancer patients

Objective To study the influence of preoperative chemoradiotherapy, preoperativechemotherapy, and operation alone on the cellular immunity in patients with middle or lower rectal cancer.Methods Ninety middle or lower rectal cancer patients were non-randomly divided into 3 equal groups:preoperative radiotherapy group, receiving conventional radiotherapy with a total dose of 30 Gy in 10 fractionscompleted within 2 weeks; preoperative chemoradiotherapy group, receiving 2 cycles of single-oral drugregimen (capecitabine 1000 mg/m2 for 2 weeks as a cycle with an interval of 1 week) and then, i. e. , 2days later, receiving conventional radiotherapy as prescribed for the patients in the preoperative radiotherapygroup; and operation alone group. Operation was performed on the patients of the former 2 groups 3 weeksafter the completion of the relevant treatment. Blood samples were collected on the admission day, 1 daybefore operation, and 7 day and 1 month after operation. Flow cytometry was used to detect the levels ofCD3+, CD2+, CD8+, CD4+/CD8+, and NK cells. Results There were no significant differences in the levelsof CD3+, CD4+, CD8+, CD4+/CD8+ , and NK cells before and after radiotherapy between the preoperativechemoradiotherapy group and preoperative chemotherapy group (all P > 0.05). 7 days after operation , thelevels of CD3+, CD4+, CD4+/CD8+, and NK cells were degraded and the CD8+ level was increasedsignificantly(all P <0.05)in all 3 groups. One month after operation , the levels of CD3+ , CD4+, CD4+/CD8+ , and NK cells were all significantly higher and the CD8+ level was significantly lower than those beforeoperation and 7 days after operation(all P < 0.05) in all 3 groups. There were no significant differences inthe T cell number and the proportions of different categories of cells at different time points in these 3 group(all P < 0.05). Conclusion Preoperative chemoradiotherapy and preoperative chemotherapy have nosignificant impact on the cellular immune function in the patients with rectal cancer.