Soria-Comes Teresa, Palomar-Abril Vicente, Martín Ureste María, García Sánchez Javier, Marco Buades Josefa Esperanza, Fernández Llavador María José, López Gabaldón Amparo, González Jurado Mar, Maestu Maiques Inmaculada Concepción
Department of Medical Oncology, Hospital Universitario Doctor Peset, Valencia, Comunitat Valenciana, Spain.
Department of Medical Oncology, Hospital Virgen de los Lirios, Alicante, Comunitat Valenciana, Spain.
Transl Cancer Res. 2020 Nov;9(11):6857-6866. doi: 10.21037/tcr-20-1997.
Aging is a risk factor for cancer and cognitive impairment, and both have been related to changes in the immune system (immunosenescence) and chronic inflammation (inflammaging) of elderly individuals. Therefore, it would be interesting to know if there is a connection between immunological variations and cognitive function in oncologic patients, especially in lung cancer, in which, inflammation plays a crucial role in tumor development and progression. Our objective is to assess, in older patients diagnosed with non-small cell lung cancer (NSCLC), differences in parameters of the immune system depending on their cognitive status.
We retrospectively analyzed patients ≥70 years diagnosed with NSCLC with evaluated cognitive function, from January 2017 to April 2019. Lymphocyte count was gathered at baseline and checked for differences in lymphocyte counts between patients with a Pfeiffer result of 0-2 3-10 mistakes. Multiple regression models were used to assess the impact of clinical parameters on lymphocyte count.
Seventy patients were analyzed. Sixty had a normal cognitive function, while ten had an impaired cognitive status; these were significantly older. Multivariate analysis showed that patients with cognitive impairment had lower levels of total, T and CD8+ T-lymphocytes (P=0.011, 0.011 and 0.019, respectively). Older age was only correlated to higher level of CD8+ T-lymphocytes (P=0.0390). Odds ratio for the risk of cognitive impairment depending on the level of T-lymphocytes was 0.996 (95% CI: 0.995-0.998), P=0.037.
T-lymphocyte count is lower in patients diagnosed with lung cancer and cognitive impairment. These findings suggest that clinical features are closely related to immunological status in older patients with NSCLC. Therefore, age cannot always explain immunosenescence, and geriatric assessment could help.
衰老既是癌症也是认知障碍的风险因素，二者均与老年人免疫系统变化（免疫衰老）及慢性炎症（炎症衰老）相关。因此，了解肿瘤患者尤其是肺癌患者（炎症在肿瘤发生发展中起关键作用）的免疫变化与认知功能之间是否存在关联很有意义。我们的目的是评估≥70岁的非小细胞肺癌（NSCLC）老年患者中，免疫系统参数根据其认知状态的差异。
我们回顾性分析了2017年1月至2019年4月诊断为NSCLC且认知功能经过评估的≥70岁患者。在基线时收集淋巴细胞计数，并检查Pfeiffer结果为0 - 2分与3 - 10分患者之间的淋巴细胞计数差异。采用多元回归模型评估临床参数对淋巴细胞计数的影响。
分析了70例患者。60例认知功能正常，10例认知状态受损；后者年龄显著更大。多因素分析显示，认知障碍患者的总淋巴细胞、T淋巴细胞和CD8⁺T淋巴细胞水平较低（分别为P = 0.011、0.011和0.019）。年龄较大仅与CD8⁺T淋巴细胞水平较高相关（P = 0.0390）。根据T淋巴细胞水平判断认知障碍风险的比值比为0.996（95%CI：0.995 - 0.998），P = 0.037。
诊断为肺癌且有认知障碍的患者T淋巴细胞计数较低。这些发现表明，老年NSCLC患者的临床特征与免疫状态密切相关。因此，年龄并不总能解释免疫衰老，老年评估可能会有所帮助。
