Polkowski W, Dabrowski A, Wallner G, Zinkiewicz K, Misiuna P
Kliniki Chirurgii Ogólnej II Katedry Chirurgii Akademii Medycznej w Lublinie.
Wiad Lek. 1997;50 Suppl 1 Pt 1:348-51.
The aim of the study was to investigate the influence of perioperative changes of the cellular immunity parameters on long-term survival following esophagectomy for carcinoma of the esophagus. In 39 patients several immunological parameters have been assessed before and 2 weeks after the operation: WBC, lymphocyte count, lymphocyte T% (E-rosette test), helper/suppressor lymphocyte T subpopulations (teophylline test), NBT test, and in vivo Multitest CMI (skin delayed hypersensitivity for recall antigens). Survival was analyzed using Kaplan-Meier method according to the stage (pTNM, UICC'92) and to the grade of perioperative cellular immunity (pCI) deterioration. Three groups of patients were identified with: 1) improvement or stabilization of pCI (n = 5); 2) deterioration of 1 or 2 pCI parameters (n = 21); and 3) deterioration of 3 or more pCI parameters (n = 13). Follow-up time ranged from 4 to 65 months. Eight patients died in hospital due to postoperative complications, 3 patients are alive (1 of them with Tis alive at 52 months of follow-up), and the remaining patients died during follow-up. Mean survival time of patients in stage II (n = 7), III (n = 17), and IV (n = 14) was 18, 17, and 6 months respectively (p = 0.017, log rank test). Mean survival time of patients in group 1, 2, and 3 was 21, 20, and 5 months respectively (p < 0.001, log rank test). On bivariate survival analysis encountering both factors, stage was found to be the only independent prognostic factor (p = 0.008, Cox regression model). Deterioration of the cellular immunity in the perioperative period is entirely related to the stage of the disease, which is the only independent prognostic factor in carcinoma of the esophagus.
本研究旨在探讨食管癌切除术后围手术期细胞免疫参数变化对长期生存的影响。对39例患者在手术前及术后2周评估了多项免疫参数：白细胞（WBC）、淋巴细胞计数、淋巴细胞T%（E-玫瑰花结试验）、辅助/抑制性淋巴细胞T亚群（氨茶碱试验）、硝基四氮唑蓝（NBT）试验以及体内多项试验CMI（对回忆抗原的皮肤迟发型超敏反应）。根据分期（pTNM，UICC'92）和围手术期细胞免疫（pCI）恶化程度，采用Kaplan-Meier法分析生存率。确定了三组患者：1）pCI改善或稳定（n = 5）；2）1或2项pCI参数恶化（n = 21）；3）3项或更多pCI参数恶化（n = 13）。随访时间为4至65个月。8例患者因术后并发症死于医院，3例患者存活（其中1例Tis患者随访52个月仍存活），其余患者在随访期间死亡。II期（n = 7）、III期（n = 17）和IV期（n = 14）患者的平均生存时间分别为18、17和6个月（p = 0.017，对数秩检验）。第1、2和3组患者的平均生存时间分别为21、20和5个月（p < 0.001，对数秩检验）。在双变量生存分析中同时考虑这两个因素时，发现分期是唯一的独立预后因素（p = 0.008，Cox回归模型）。围手术期细胞免疫恶化完全与疾病分期相关，而疾病分期是食管癌唯一的独立预后因素。
