Wu Bo, Zhao Shengchao, Sheng Yaru, Ren Lu, Song Guoquan
Mudanjiang Medical University, Mudanjiang City Xinxiang Medical University, Xinxiang Hongqi Affiliated Hospital To Mudanjiang Medical University, Mudanjiang City, China.
Medicine (Baltimore). 2018 Aug;97(34):e11972. doi: 10.1097/MD.0000000000011972.
A positive circumferential resection margin (CRM) may result in local recurrence (LR), but the significance remains controversial. We attempted to utilize the lymphocyte ratio (LYMR), neutrophil-lymphocyte ratio (NLR), tumor-infiltrating lymphocyte (TIL) count, and their combinations (TIL-LYMR/TIL-NLR) in predicting LR after rectal resection.
Patients with rectal cancer who underwent curative resection between January 2016 and December 2018 were enrolled. Biopsy samples and data from the blood tests of 124 patients with rectal cancer who underwent curative resection were retrospectively obtained. Patients were divided into 2 groups: LR group and non-local recurrence (nLR) group. CD8 + TILs were immunostained using an antibody against CD8. The density of TILs was defined as the number of positive CD8 lymphocytes per square millimeter and was then graded as either high or low (cutoff = 80/mm). The count of LYMR and NLR was also graded as either high or low. The associations between TILs, LYMR, NLR, and their combinations (TIL-LYMR/TIL-NLR) were evaluated.
With a median follow-up of 24.4 months, TIL-LYMR showed a positive correlation with LR (P = .001), but not with the CD8 + TIL count (P = .215) or TIL-NLR count (P = .638). Among inflammatory and immune markers variables, univariate analysis revealed that gender, CD8 + TIL count, and TIL-NLR count were associated with anastomotic leakage (P = .001, P = .014, and P = .036, respectively). In multivariate analysis, TIL-LYMR remained an independent predictor of LR (OR = 8.918, CI = 1.124-70.747, P = .038). We also showed that gender associated with anastomotic leakage in rectal cancer (OR 5.429; 95% CI 1.885-15.637; P = .002).
In this study, our data indicate that absence of CD8 + T-cell infiltration in CRM may influence LR. These parameters may help identify LR provide additional information for therapeutic decision-making.
环周切缘（CRM）阳性可能导致局部复发（LR），但其意义仍存在争议。我们试图利用淋巴细胞比率（LYMR）、中性粒细胞与淋巴细胞比率（NLR）、肿瘤浸润淋巴细胞（TIL）计数及其组合（TIL-LYMR/TIL-NLR）来预测直肠癌切除术后的局部复发。
纳入2016年1月至2018年12月期间接受根治性切除的直肠癌患者。回顾性获取124例行根治性切除的直肠癌患者的活检样本和血液检测数据。患者分为两组：局部复发组（LR组）和无局部复发组（nLR组）。使用抗CD8抗体对CD8 + TILs进行免疫染色。TILs的密度定义为每平方毫米阳性CD8淋巴细胞的数量，然后分为高或低（临界值 = 80/mm）。LYMR和NLR计数也分为高或低。评估TILs、LYMR、NLR及其组合（TIL-LYMR/TIL-NLR）之间的关联。
中位随访24.4个月，TIL-LYMR与局部复发呈正相关（P = 0.001），但与CD8 + TIL计数（P = 0.215）或TIL-NLR计数（P = 0.638）无关。在炎症和免疫标志物变量中，单因素分析显示性别、CD8 + TIL计数和TIL-NLR计数与吻合口漏相关（分别为P = 0.001、P = 0.014和P = 0.036）。多因素分析中，TIL-LYMR仍然是局部复发的独立预测因素（OR = 8.918，CI = 1.124 - 70.747，P = 0.038）。我们还表明性别与直肠癌吻合口漏相关（OR 5.429；95% CI 1.885 - 15.637；P = 0.002）。
在本研究中，我们的数据表明CRM中缺乏CD8 + T细胞浸润可能影响局部复发。这些参数可能有助于识别局部复发，为治疗决策提供额外信息。
