Burgess Brian, Levine Beverly, Taylor Robert N, Kelly Michael G
Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, KY, 40536, USA.
Department of Social Sciences and Health Policy, Wake Forest University Comprehensive Cancer Center, Winston-Salem, NC, 27157, USA.
Reprod Sci. 2020 Jan;27(1):194-203. doi: 10.1007/s43032-019-00009-4. Epub 2020 Jan 1.
Tumor-associated macrophages and tumor-infiltrating lymphocytes are associated with survival in solid malignancies. Given the physiological link to peripheral immune cell counts, we evaluated if peripheral immune cell counts were predictors of outcomes in endometrial cancer. A retrospective study was completed for endometrial cancer cases between 2000 and 2010. Kaplan-Meier, bivariate, and multivariable Cox proportion hazard analyses were performed examining the relations between survival and peripheral immune cell counts. Three hundred ten patients were identified. In bivariate analyses, high monocyte counts (> 0.7 × 10 cells/L) trended with decreased progression free survival (PFS) (p = 0.10) and poorer overall survival (OS) (p = 0.16). By contrast, high lymphocyte level (> 1.5 × 10 cells/L) was associated with improved PFS (p = 0.008) and OS (p = 0.006). These findings were consistent for type I and type II endometrial cancers. In a multivariable Cox model, high monocyte level was associated with a greater risk of disease recurrence (hazard ratio (HR) = 1.63, p < 0.035). Other significant predictors of recurrence were age, non-endometrioid histology, and the presence of lymph vascular space invasion (LVSI). In a multivariable Cox model, high lymphocyte count trended with a lower risk of death (HR = 0.66, p = 0.07). Age, surgical stage, non-endometrioid histology, and LVSI were also associated with death in this model. In this sample of endometrial cancer patients, we found that high preoperative lymphocyte counts were associated with improved overall improved survival. High monocyte counts were associated with poorer disease-free survival outcomes. Further studies that focused on understanding tumor-antagonizing and pro-tumoral effects of lymphocytes and monocytes, respectively, in endometrial cancer are recommended.
肿瘤相关巨噬细胞和肿瘤浸润淋巴细胞与实体恶性肿瘤的生存率相关。鉴于与外周免疫细胞计数的生理联系，我们评估了外周免疫细胞计数是否为子宫内膜癌预后的预测指标。对2000年至2010年间的子宫内膜癌病例进行了一项回顾性研究。进行了Kaplan-Meier、双变量和多变量Cox比例风险分析，以检验生存率与外周免疫细胞计数之间的关系。共确定了310例患者。在双变量分析中，高单核细胞计数（>0.7×10⁹细胞/L）与无进展生存期（PFS）降低（p = 0.10）和总生存期（OS）较差（p = 0.16）呈趋势性相关。相比之下，高淋巴细胞水平（>1.5×10⁹细胞/L）与改善的PFS（p = 0.008）和OS（p = 0.006）相关。这些发现对于I型和II型子宫内膜癌是一致的。在多变量Cox模型中，高单核细胞水平与疾病复发风险增加相关（风险比（HR）= 1.63，p < 0.035）。复发的其他重要预测因素是年龄、非子宫内膜样组织学以及淋巴血管间隙浸润（LVSI）的存在。在多变量Cox模型中，高淋巴细胞计数与较低的死亡风险呈趋势性相关（HR = 0.66，p = 0.07）。在该模型中，年龄、手术分期、非子宫内膜样组织学和LVSI也与死亡相关。在这个子宫内膜癌患者样本中，我们发现术前高淋巴细胞计数与总体生存期改善相关。高单核细胞计数与较差的无病生存结果相关。建议进一步开展研究，分别聚焦于了解淋巴细胞和单核细胞在子宫内膜癌中抗肿瘤和促肿瘤的作用。
