淋巴细胞亚群对晚期非小细胞肺癌患者化疗效果及远期生存的影响

摘要

目的 评估淋巴细胞亚群对晚期非小细胞肺癌(NSCLC)患者化疗效果及远期生存的影响.方法 以125例接受紫杉醇±铂类、培美曲塞±铂类或其他一线化疗方案的晚期NSCLC患者为研究对象,采用流式细胞仪检测化疗前及化疗2个周期后的外周血21项淋巴细胞亚型的表达情况,根据影像学检查结果评价化疗疗效,分析淋巴细胞亚群对患者疗效和无进展生存时间(PFS)及总生存时间(OS)的影响.结果 不同化疗疗效组患者化疗前的淋巴细胞亚群间差异均无统计学意义(P均>0.05);2周期化疗后,完全缓解(CR)+部分缓解(PR)组、疾病稳定(SD)组和疾病进展(PD)组患者的CD4+CD29+细胞百分比分别为(22.42±7.88)%、(21.88±6.81)%和(16.87±5.28)%,其中,PD组明显低于CR+PR组(P=0.013)和SD组(P=0.009).中位PFS为7.07个月,中位OS为23.00个月.COX多因素回归分析结果显示,化疗前HLA-DR+细胞(HR:1.03,95%CI:1.01~1.05,P<0.001)及CD3+HLA-DR+细胞(HR:1.05,95%CI:1.01~1.08,P<0.001)表达水平与患者的OS呈显著正相关.结论 化疗后CD4+CD29+T淋巴细胞水平升高可能提示患者的化疗效果较好.化疗前HLA-DR+细胞及CD3+HLA-DR+细胞在外周血中所占百分比越高,可能提示患者的预后越好.%Objective To analyze the impact of lymphocyte subsets on chemotherapy efficacy and long-term survival of patients with advanced non-small cell lung cancer(NSCLC).Methods Totally 125 NSCLC patients who had received first-line chemotherapy including paclitaxel and pemetrexed with/without platinum were enrolled in this study.Lymphocytes from peripheral blood were collected before and after two cycles of first-line chemotherapy.Flow cytometry was performed to determine the expressions of 21 fluorescence-labeled lymphocyte subsets.Based on the imaging findings,chemotherapy efficacy was evaluated,and impact of the lymphocyte subsets on progression-free survival(PFS)and overall survival(OS)were analyzed.Results The baseline peripheral lymphocyte subsets showed no significant difference among groups receiving different treatment protocols(all P>0.05).After 2 cycles of chemotherapy,the percentage of CD4+CD29+lymphocytes was(16.87±5.28)% in progressive disease group,which was significantly lower than those in complete remission+partial remission group [(22.42±7.88)%,P=0.013] and stable disease group [(21.88±6.81)%,P=0.009].The median PFS was 7.07 months and median OS was 23.00 months.Cox multivariable regression analysis showed that the percentages of HLA-DR+(HR:1.03,95%CI:1.01-1.05,P<0.001) and CD3+HLA-DR+lymphocytes (HR:1.05,95%CI:1.01-1.08,P<0.001)were positively correlated with OS.Conclusions The rise of CD4+CD29+T lymphocytes in patients after chemotherapy indicates good chemotherapy efficacy.Higher percentage of HLA-DR+and CD3+HLA-DR+lymphocytes in peripheral blood before chemotherapy predicts favorable prognosis.