Di Giorgio A, Mingazzini P, Sammartino P, Canavese A, Arnone P, Scarpini M
Department of Surgery "Pietro Valdoni" (ex I Istituto di Clinica Chirurgica), Rome, Italy.
Cancer. 2000 Nov 15;89(10):2038-45. doi: 10.1002/1097-0142(20001115)89:10<2038::aid-cncr2>3.0.co;2-j.
Numerous studies have investigated locoregional immune responses and long term survival in patients with various types of cancer; few have focused on patients with lung carcinoma. The current study was designed to assess the prognostic value of immunomorphologic changes in locoregional lymph nodes and lymphocytic infiltration of primary tumor (LI) in patients who undergo resection for bronchogenic carcinoma.
In a retrospective analysis, immune responses in locoregional lymph nodes and at primary tumor sites were studied histologically in 172 selected patients. Lymph node morphology was studied according to the system of Cottier et al. Sinus histiocytosis and paracortical lymphoid cell hyperplasia were considered to be cellular immune responses, and follicular hyperplasia of the cortical area was considered to be a humoral reaction. LI was classified with Black's method. The survival rate was estimated by using the Kaplan-Meier product-limit method. The log rank test and the Cox proportional-hazards model were used to determine statistical significance in univariate and multivariate survival analyses.
Among the 172 patients, 35.5% had no evident response in regional lymph nodes, 19.8% had a marked cellular response, 11% had a marked humoral response, and 33.7% had a mixed cellular and humoral response. LI was intense in 36.6% of patients and was absent or scarcely evident in 63.4%. A lymph node cellular response and marked LI improved long term survival rates even in patients with regional lymph node metastases. Multivariate analysis identified two independent variables that had high prognostic value: lymph node immunoreactivity and LI.
Lymph node immunoreactivity and LI significantly influence long term survival after curative surgery for patients with carcinoma of the lung and may be useful in stratifying patients for prospective trials of adjuvant treatment, including immunotherapy.
众多研究已对各类癌症患者的局部区域免疫反应和长期生存情况进行了调查；但针对肺癌患者的研究较少。本研究旨在评估接受支气管源性癌切除术患者的局部区域淋巴结免疫形态学变化及原发性肿瘤淋巴细胞浸润（LI）的预后价值。
在一项回顾性分析中，对172例选定患者的局部区域淋巴结和原发性肿瘤部位的免疫反应进行了组织学研究。根据科蒂尔等人的系统对淋巴结形态进行研究。窦组织细胞增生和副皮质区淋巴细胞增生被视为细胞免疫反应，皮质区滤泡增生被视为体液反应。LI采用布莱克法进行分类。采用Kaplan-Meier乘积限界法估计生存率。对数秩检验和Cox比例风险模型用于确定单因素和多因素生存分析中的统计学意义。
在172例患者中，35.5%的患者区域淋巴结无明显反应，19.8%的患者有明显的细胞反应，11%的患者有明显的体液反应，33.7%的患者有细胞和体液混合反应。36.6%的患者LI强烈，63.4%的患者LI缺失或几乎不明显。即使在有区域淋巴结转移的患者中，淋巴结细胞反应和明显的LI也能提高长期生存率。多因素分析确定了两个具有高预后价值的独立变量：淋巴结免疫反应性和LI。
淋巴结免疫反应性和LI对肺癌患者根治性手术后的长期生存有显著影响，可能有助于对患者进行分层，以开展包括免疫治疗在内的辅助治疗前瞻性试验。
