Du Zhongze, Xiao Youming, Deng Guiming, Song Haibin, Xue Yingwei, Song Hongjiang
Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China.
Department of Pediatric Surgery, YaAn People's Hospital, Ya'an, Sichuan, China.
J Cachexia Sarcopenia Muscle. 2024 Aug;15(4):1587-1600. doi: 10.1002/jcsm.13517. Epub 2024 Jun 18.
This study aimed to investigate the predictive capacity of lymphocyte subpopulations, sarcopenia and myosteatosis for clinical outcomes in patients who underwent gastric cancer surgery. Additionally, the prognostic significance of CD3+/CD4+ cells in conjunction with myosteatosis was explored.
A cohort of 190 patients with gastric cancer who underwent surgery and received computed tomography scans between July 2016 and December 2017 at our institution was examined. Complete clinical information and peripheral lymphocyte subpopulations were available for all patients. A comprehensive array of statistical methodologies was employed to scrutinize variances in both clinical and pathological characteristics among patients, with the aim of identifying autonomous prognostic determinants requisite for the development of a nomogram. Subsequent assessment of the predictive efficacy of the nomogram was conducted via calibration curve analysis.
The study comprised a cohort of 190 participants, encompassing 126 males (66.32%) and 64 females (33.68%), with a mean age of 58.47 (±11.37) years. Patients were stratified into three groups based on CD3+/CD4+ cells and myosteatosis, with 24 in Group 1, 87 in Group 2 and 79 in Group 3. Notably, patients in the third group exhibited significantly shorter progression-free survival (PFS) (hazard ratio [HR] = 0.208, P < 0.001) and overall survival (OS) (HR = 0.193, P < 0.001). The subset of peripheral blood lymphocytes exhibited elevated levels of CD3+/CD4+ cells (HR = 2.485, P < 0.001) and heightened CD4+/CD8+ ratios (HR = 1.705, P = 0.038), whereas diminished CD19+ cell counts (HR = 0.210, P = 0.032) correlated with improved OS in patients. The individuals presenting with sarcopenia (HR = 4.089, P = 0.023) and myosteatosis (HR = 2.857, P < 0.001) displayed reduced OS. The multivariate Cox regression analysis showed that pathological tumour-node-metastasis stage, CD19+ cells, sarcopenia and CD3+/CD4+ cell-myosteatosis were identified as independent prognostic factors for PFS and OS in patients. The constructed nomograms for PFS and OS yielded C-index values of 0.839 (95% confidence interval [CI]: 0.798-0.880) and 0.836 (95% CI: 0.792-0.879), respectively. The calibration analysis demonstrated that the nomograms accurately predicted the 3- and 5-year survival rates of PFS and OS in patients.
Lymphocyte subsets, including CD3+/CD4+ cells, CD4+/CD8+ ratio and CD19+ cells, are indicative of clinical prognosis in gastric cancer surgery patients. Body composition parameters, such as sarcopenia and myosteatosis, are also associated with the patient's prognosis. The combination of CD3+/CD4+ cells with myosteatosis demonstrates enhanced prognostic value, enabling the identification of patients at high risk of post-operative metastasis and recurrence.
本研究旨在探讨淋巴细胞亚群、肌肉减少症和肌脂肪变性对接受胃癌手术患者临床结局的预测能力。此外，还探讨了CD3⁺/CD4⁺细胞与肌脂肪变性联合的预后意义。
对2016年7月至2017年12月在本机构接受手术并接受计算机断层扫描的190例胃癌患者进行队列研究。所有患者均有完整的临床信息和外周血淋巴细胞亚群数据。采用一系列统计方法来研究患者临床和病理特征的差异，以确定构建列线图所需的独立预后决定因素。随后通过校准曲线分析对列线图的预测效能进行评估。
该研究队列包括190名参与者，其中男性126名（66.32%），女性64名（33.68%），平均年龄58.47（±11.37）岁。根据CD3⁺/CD4⁺细胞和肌脂肪变性将患者分为三组，第1组24例，第2组87例，第3组79例。值得注意的是，第三组患者的无进展生存期（PFS）显著缩短（风险比[HR]=0.208，P<0.001），总生存期（OS）也显著缩短（HR=0.193，P<0.001）。外周血淋巴细胞亚群中，CD3⁺/CD4⁺细胞水平升高（HR=2.485，P<0.001）和CD4⁺/CD8⁺比值升高（HR=1.705，P=0.038），而CD19⁺细胞计数减少（HR=0.210，P=0.032）与患者OS改善相关。出现肌肉减少症（HR=4.089,P=0.023）和肌脂肪变性（HR=2.857,P<0.001）的患者OS降低。多因素Cox回归分析显示，病理肿瘤-淋巴结-转移分期、CD19⁺细胞、肌肉减少症和CD3⁺/CD4⁺细胞-肌脂肪变性被确定为患者PFS和OS的独立预后因素。构建的PFS和OS列线图的C指数值分别为0.839（95%置信区间[CI]：0.798-0.880）和0.836（95%CI：0.792-0.879）。校准分析表明，列线图准确预测了患者PFS和OS的3年和5年生存率。
包括CD3⁺/CD4⁺细胞、CD4⁺/CD8⁺比值和CD19⁺细胞在内的淋巴细胞亚群可指示胃癌手术患者的临床预后。身体成分参数，如肌肉减少症和肌脂肪变性，也与患者预后相关。CD3⁺/CD4⁺细胞与肌脂肪变性联合具有更高的预后价值，有助于识别术后转移和复发风险高的患者。
