外周血淋巴细胞亚群作为结直肠癌的预后因素

Lymphocyte subsets in peripheral blood as prognostic factors in colorectal cancer.

作者信息

Milasiene V, Stratilatovas E, Norkiene V, Jonusauskaite R

机构信息

Laboratory of Experimental Oncology, Institute of Oncology, Vilnius University, Vilnius, Lithuania.

出版信息

J BUON. 2005 Apr-Jun;10(2):261-4.

PMID:17343340

Abstract

PURPOSE

To evaluate changes in different parameters of the immune status of colorectal cancer patients before their surgical treatment and to look for a possible impact these parameters could exert on overall survival.

PATIENTS AND METHODS

Forty patients with histologically confirmed colorectal cancer in stage II (n=22), III and IV (n=18) were eligible for inclusion in the present study. Heparinized venous blood (5 ml) of patients was examined 5 days before surgery. Their preoperative white blood cell (WBC) count was >/=3.010(9)/l, hemoglobin >/=10 g/l, and platelets >/=18010(9)/l. The indices of cellular immunity determined for all of the patients were the following: total leukocyte number, absolute number and percents of total lymphocytes, monocytes and neutrophils. The percentage and absolute number of lymphocytes subsets CD3(+), T-helpers (CD4(+)), T-cytotoxic cells (CD8(+)), immunoregulation index (CD4(+)/CD8(+)), B-lymphocytes (CD20(+)), natural killer (NK) cells (CD16(+)) were measured by immunofluorescence methods.

RESULTS

Cox regression analysis showed no dependence of the survival on estimated cellular immunity parameters of colorectal cancer patients in stage II. However, the number of circulating lymphocytes and in particular of T cells and NK cells was an independent prognostic variable for overall survival of stage III and IV patients. Analyzing the dependence of survival on immunological indices of colorectal cancer patients, a significant dependence of survival was determined on the absolute preoperative number of total lymphocytes and lymphocyte subsets (total lymphocytes levels >/=1.210(9)/l, >/=CD3(+) >/=0.810(9)/l, CD4(+) >/=0.3* 10(9)/l, CD8(+) >/=0.310(9)/l, and CD16(+)>/=0.2510(9)/l). Cox regression analysis showed that higher absolute number of lymphocyte subpopulations may be associated with longer survival of colorectal cancer patients in stage III and IV.

CONCLUSION

This study suggests total number of lymphocytes >/=1.210(9)/l, CD3(+) >/=0.810(9)/l, CD4(+) >/=0.3* 10(9)/l, CD8(+) >/=0.310(9)/l, and CD16(+) >/=0.2510(9)/l before surgery have a beneficial effect on overall survival of colorectal cancer patients in advanced stages (III and IV) of the disease.

摘要

目的

评估结直肠癌患者手术治疗前免疫状态不同参数的变化，并探寻这些参数对总生存期可能产生的影响。

患者与方法

40例经组织学确诊为Ⅱ期（n = 22）、Ⅲ期和Ⅳ期（n = 18）的结直肠癌患者符合本研究纳入标准。在手术前5天采集患者的肝素化静脉血（5 ml）。患者术前白细胞（WBC）计数≥3.0×10⁹/L，血红蛋白≥10 g/L，血小板≥180×10⁹/L。为所有患者测定的细胞免疫指标如下：白细胞总数、总淋巴细胞、单核细胞和中性粒细胞的绝对数及百分比。采用免疫荧光法检测淋巴细胞亚群CD3⁺、辅助性T细胞（CD4⁺）、细胞毒性T细胞（CD8⁺）、免疫调节指数（CD4⁺/CD8⁺）、B淋巴细胞（CD20⁺）、自然杀伤（NK）细胞（CD16⁺）的百分比及绝对数。

结果

Cox回归分析显示，Ⅱ期结直肠癌患者的生存期与估计的细胞免疫参数无关。然而，循环淋巴细胞数量，尤其是T细胞和NK细胞数量，是Ⅲ期和Ⅳ期患者总生存期的独立预后变量。分析结直肠癌患者生存期与免疫指标的相关性发现，生存期与术前总淋巴细胞及淋巴细胞亚群的绝对数显著相关（总淋巴细胞水平≥1.2×10⁹/L，CD-3⁺≥0.8×10⁹/L，CD4⁺≥0.3×10⁹/L，CD8⁺≥0.3×10⁹/L，CD16⁺≥0.25×10⁹/L）。Cox回归分析表明，较高的淋巴细胞亚群绝对数可能与Ⅲ期和Ⅳ期结直肠癌患者较长的生存期相关。