CD+8T细胞水平评价Ⅲ-Ⅳ期非小细胞肺癌放化疗预后价值

目的 探讨Ⅲ-Ⅳ期非小细胞肺癌(NSCLC)放化疗前后外周血CD⁺₈T细胞水平及其变化规律预测生存的临床价值。方法 收集2011-2017年完成外周血CD⁺₈T细胞检测的Ⅲ-Ⅳ期NSCLC共 795例(其中 249例疗后6个月内完成 1~3次检测),分析治疗前后CD⁺₈T细胞不同水平的生存差异及其变化规律对生存的预测作用。Kaplan-Meier生存分析并log-rank检验和单因素预后分析,Cox模型多因素预后分析。结果 795例患者不同临床因素的疗前外周血CD⁺₈T细胞水平相近,Ⅲ期NSCLC中<26.44%生存期显著延长(P=0.043)。疗后CD⁺₈T细胞水平较疗前显著升高且 1~3个月内水平相似,4~6个月下降但仍然显著高于疗前。249例疗后CD⁺₈T细胞<43.90%水平的中位生存期高于≥43.90%的(22个月∶16个月,P=0.032),但分层分析疗后1、2~3个月的生存期相近(P>0.05),而 4~6个月显示生存期不同(P=0.001)。多因素分析显示疗后CD⁺₈T细胞<43.90%是延长生存的独立预后因素(HR=0.714,P=0.031)。结论 Ⅲ-Ⅳ期NSCLC外周血疗前CD⁺₈T细胞预测预后作用有限,疗后CD⁺₈T细胞显著升高;一定水平的升高可延长生存期,过度升高对生存不利;CD⁺₈T细胞亚型检测更重要。

Prognostic value of peripheral blood CD+8T lymphocytes for stage Ⅲ-Ⅳ non-small cell lung cancer patients treated with chemoradiotherapy

Objective To explore the changes of CD⁺₈ T cells in stage Ⅲ-Ⅳ non-small cell lung cancer (NSCLC) patients before and after radiochemotherapy and evaluate its clinical value in predicting survival. Methods A total of 795 patients with stage Ⅲ-Ⅳ NSCLC who completed CD⁺₈ T cell testing from January 2011 to December 2017 were recruited (249 patients completed 1-3 tests within 6 months after treatment). The survival difference of patients with different levels of CD⁺₈ T cells and the prognostic value of the changes in the CD⁺₈ T cell level were analyzed. The survival analysis was performed by Kaplan-Meier method and log-rank test or univariate analysis. The multivariate survival analysis was conducted by Cox’s regression model. Results Before treatment, the levels of CD⁺₈ T cells in the peripheral blood did not significantly differ among patients with different clinical factors. The survival time of stage Ⅲ NSCLC patients with CD⁺₈ T cell levels of<26.44% was significantly prolonged (P=0.043). After treatment, the levels of CD⁺₈ T cells were significantly higher than those before treatment. The levels were similar within 1-3 months, decreased after 4-6 months but still significantly higher than those before treatment. The median survival time of patients with CD⁺₈cell levels of<43.90% after treatment was 22 months, significantly longer than 16 months of those with CD⁺₈cell levels of ≥43.90%(P=0.032). Stratified analysis demonstrated no significant difference in the survival time at 1 month and 2-3 months after treatment (P>0.05), whereas the survival time significantly differed at 4-6 months (P=0.001). The multivariate survival analysis showed that CD⁺₈ cell levels of<43.90% after treatment was an independent prognostic factor (HR=0.714, P=0.031). Conclusions The effect of CD⁺₈ T cells on prognosis of patients with stage Ⅲ-Ⅳ NSCLC is limited. After treatment, CD⁺₈ T cell levels are increased significantly. A certain increase in the CD⁺₈ T cell levels can prolong the survival time. The detection of CD⁺₈ T cell subtypes plays a more significant role.