老年肾癌患者血清T淋巴细胞亚群变化对其预后及生存的影响
|
摘要
目的:探讨分析老年肾癌患者血清T淋巴细胞亚群变化对其预后及生存的影响。方法:选择2013年4月至2015年3月我院收治的78例老年肾癌患者,再选择同期来我院体检的健康人群50例作为对照组,术前以及术后2周采用流式细胞技术检测肾癌患者外周血T淋巴细胞亚群水平变化情况,并与对照组比较。对患者进行随访分析,采用Kaplan-Meier生存分析术后不同T淋巴细胞亚群水平对患者生存预后的影响。结果:肾癌组患者术前、术后2周外周血CD3~+、CD4~+以及CD4~+/CD8~+水平均显著低于对照组(P <0. 05)。肾癌组术后2周外周血CD3~+、CD4~+以及CD4~+/CD8~+水平较术前有显著升高(P <0. 05)。CD3~+> 48%肾癌患者总体生存情况显著优于CD3~+≤48%患者(P <0. 05)。CD4~+> 30%肾癌患者总体生存情况显著优于CD4~+≤30%患者(P <0. 05)。CD8~+> 25%肾癌患者总体生存情况与CD8~+≤25%患者生存情况无差异(P>0. 05)。CD4~+/CD8~+> 1. 0肾癌患者总体生存情况显著优于CD4~+/CD8~+≤1. 0患者(P <0. 05)。结论:老年肾癌患者存在广泛的细胞免疫功能紊乱现象,手术治疗后能够有效去除瘤负荷而从一定程度上逆转免疫功能,术后免疫功能指标可反映患者预后情况,免疫功能状态越差的患生存情况越差。
Objective: To investigate and analyze the influence of the changes of serum T lymphocyte subsets on the prognosis and survival of the elderly patients with renal cancer. Methods: 78 cases of elderly patients with renal cell carcinoma in April 2013 to March 2015 in our hospital were collected,and healthy people at the same time to the hospital physical examination in 50 cases as control group,using flow cytometry to detect the changes of renal cell carcinoma patients with peripheral blood T lymphocyte subsets level condition of preoperative and postoperative 2 weeks,compared with control group. The patients were followed up to analyze the effect of different T lymphocyte subsets after Kaplan-Meier survival analysis on the survival prognosis of the patients. Results: Before and 2 weeks after operation,the levels of CD3~+,CD4~+and CD4~+/CD8~+in the peripheral blood of the renal cancer group were significantly lower than those in the control group( P < 0. 05). The levels of CD3~+,CD4~+and CD4~+/CD8~+in the peripheral blood of the renal cell carcinoma group were significantly higher than those before the operation 2 weeks after operation( P <0. 05). CD3~+> 48% of renal cell carcinoma patients overall survival was significantly better than that of CD3~+≤48% patients( P < 0. 05). CD4~+> 30% of renal cell carcinoma patients overall survival was significantly better than that of CD4~+≤30% patients( P < 0. 05). CD8~+> 25% patients with overall survival and survival of patients with CD8~+≤25% had no difference( P > 0. 05). CD4~+/CD8~+> 1. 0 renal cell carcinoma patients overall survival was significantly better than that of CD4~+/CD8~+≤1. 0 patients( P <0. 05). Conclusion: Elderly patients with renal cell carcinoma has cell immune function disorder phenomenon. Surgical treatment can effectively remove the tumor burden and to some extent revers immune function and immune function after surgery can reflect the prognosis of patients.Worse immune function showed worse prognosis.
Objective: To investigate and analyze the influence of the changes of serum T lymphocyte subsets on the prognosis and survival of the elderly patients with renal cancer. Methods: 78 cases of elderly patients with renal cell carcinoma in April 2013 to March 2015 in our hospital were collected,and healthy people at the same time to the hospital physical examination in 50 cases as control group,using flow cytometry to detect the changes of renal cell carcinoma patients with peripheral blood T lymphocyte subsets level condition of preoperative and postoperative 2 weeks,compared with control group. The patients were followed up to analyze the effect of different T lymphocyte subsets after Kaplan-Meier survival analysis on the survival prognosis of the patients. Results: Before and 2 weeks after operation,the levels of CD3~+,CD4~+and CD4~+/CD8~+in the peripheral blood of the renal cancer group were significantly lower than those in the control group( P < 0. 05). The levels of CD3~+,CD4~+and CD4~+/CD8~+in the peripheral blood of the renal cell carcinoma group were significantly higher than those before the operation 2 weeks after operation( P <0. 05). CD3~+> 48% of renal cell carcinoma patients overall survival was significantly better than that of CD3~+≤48% patients( P < 0. 05). CD4~+> 30% of renal cell carcinoma patients overall survival was significantly better than that of CD4~+≤30% patients( P < 0. 05). CD8~+> 25% patients with overall survival and survival of patients with CD8~+≤25% had no difference( P > 0. 05). CD4~+/CD8~+> 1. 0 renal cell carcinoma patients overall survival was significantly better than that of CD4~+/CD8~+≤1. 0 patients( P <0. 05). Conclusion: Elderly patients with renal cell carcinoma has cell immune function disorder phenomenon. Surgical treatment can effectively remove the tumor burden and to some extent revers immune function and immune function after surgery can reflect the prognosis of patients.Worse immune function showed worse prognosis.
引文
[1]Zhou Li,Cui Chuanliang,Guo Jun,et al. New progress in clinical research of immunotherapy for metastatic renal cell carcinoma[J].Chin J Oncol,2016,43(22):973-976.[周莉,崔传亮,郭军,等.转移性肾癌免疫治疗临床研究新进展[J].中国肿瘤临床,2016,43(22):973-976.]
[2]Wang Shuhua,Liao Wenfeng,Lin Rui,et al. The relationship between the ratio of neutrophils to lymphocyte in peripheral blood and prognosis of renal cell carcinoma before operation[J]. Chinese Department of Urology,2015,36(11):812-817.[王书华,廖文峰,林瑞,等.术前外周血中性粒细胞与淋巴细胞的比值和肾癌预后的关系[J].中华泌尿外科杂志,2015,36(11):812-817.]
[3]Lamers CH,Sleijfer S,Steenbergen S,et al. Treatment of metastatic renal cell carcinoma with CAIX CAR-engineered T cells:clinical evaluation and management of on-target toxicity[J]. Mol Ther,2013,21(4):904-912.
[4]Liu XD,Hoang A,Zhou L,et al. Resistance to antiangiogenic therapy is associated with an immunosuppressive tumor microenvironment in metastatic renal cell carcinoma[J]. Cancer Immunol Res,2015,3(9):1017-1029.
[5]Yeh CR,Ou ZY,Xiao GQ,et al. Infiltrating T cells promote renal cell carcinoma(RCC)progression via altering the estrogen receptorβ-DAB2IP signals[J]. Oncotarget,2015,6(42):44346-44359.
[6]Yao Dayong,Shi Ce,Xia Shunyao,et al. Study on the relationship between the ratio of neutrophils/lymphocyte in peripheral blood and the clinicopathological features and prognosis of renal carcinoma[J]. Modern Biomedical Progress,2016,16(32):6379-6383,6209.[姚大勇,史策,夏舜尧,等.术前外周血中性粒细胞/淋巴细胞比值与肾癌临床病理特点及预后关系的研究[J].现代生物医学进展,2016,16(32):6379-6383,6209.]
[7]Yang L,Wu X,Wang D,et al. Renal carcinoma cell-derived exosomes induce human immortalized line of Jurkat T lymphocyte apoptosis in vitro[J]. Urol Int,2013,91(3):363-369.
[8]Guislain A,Gadiot J,Kaiser A,et al. Sunitinib pretreatment improves tumor-infiltrating lymphocyte expansion by reduction in intratumoral content of myeloid-derived suppressor cells in human renal cell carcinoma[J]. Cancer Immunol Immunother,2015,64(10):1241-1250.
[9]Zhang Jinchao,Yang Yanli,Sun Xuedong,et al. Effect analysis and follow-up observation of autologous dendritic cells combined with cytokine induced killer cells in the treatment of metastatic renal carcinoma[J]. Liberation Army Medical Journal,2016,41(10):827-832.[张金超,杨岩丽,孙雪冬,等.自体树突细胞联合细胞因子诱导的杀伤细胞治疗转移性肾癌的疗效分析及随访观察[J].解放军医学杂志,2016,41(10):827-832.]
[10]Kawashima H,Obayashi A,Kawamura M,et al. Galectin 9 and PINCH,novel immunotherapy targets of renal cell carcinoma:a rationale to find potential tumour antigens and the resulting cytotoxic T lymphocytes induced by the derived peptides[J]. BJU Int,2014,113(2):320-332.
[11]Zhang Li,Leng J,Yu Miao,et al. Effects of serum T lymphocyte subsets on the condition and survival of renal cell carcinoma[J].Clinical and Experimental Medicine,2017,16(19):1943-1945.[张莉,冷俊,郁淼,等.血清T淋巴细胞亚群对肾癌病情与生存状况的影响[J].临床和实验医学杂志,2017,16(19):1943-1945.]
[12]Weiss JM,Gregory Alvord W,Quinones OA,et al. CD40 expression in renal cell carcinoma is associated with tumor apoptosis,CD8(+)T cell frequency and patient survival[J]. Hum Immunol,2014,75(7):614-620.
[13]Han Xuebing,Chen Huiqing,Liu Jianwu,et al. Detection of immune function in patients with renal cell carcinoma before and after operation and its clinical significance[J]. Chinese Medicine and Clinic,2017,17(12):1749-1753.[韩雪冰,陈惠庆,刘建武,等.肾癌患者手术前后免疫功能检测及其临床意义[J].中国药物与临床,2017,17(12):1749-1753.]
[14]Ma Qingchang,Li Yanjiang,Zhao Zhenwei,et al. The prognostic significance of neutrophils,lymphocytes and their ratios to renal cell carcinoma[J]. Modern Oncology,2015,23(2):250-254.[马清昌,李延江,赵振威,等.中性粒、淋巴细胞及两者比值对肾癌的预后意义[J].现代肿瘤医学,2015,23(2):250-254.]
[15]Thiery-Vuillemin A,Laheurte C,Mansi L,et al. Immunomodulatory effects of everolimus in a long responsive patient with metastatic renal cell carcinoma[J]. J Immunother,2014,37(1):51-54.
[16]Meng FD,Sui CG,Tian X,et al. Heat-shock protein 70 as a tumor antigen for in vitro dendritic cell pulsing in renal cell carcinoma cases[J]. Asian Pac J Cancer Prev,2014,15(20):8947-8950.
[17]Wang Bingwei,Yang Guosheng,Fan Lixin,et al. Effect of retroperitoneoscopy on immune function and neuroendocrine function in patients with renal carcinoma[J]. Chinese Journal of Experimental Surgery,2014,31(6):1187-1189.[王炳卫,杨国胜,范立新,等.后腹腔镜手术对肾癌患者免疫功能及神经内分泌功能的影响[J].中华实验外科杂志,2014,31(6):1187-1189.]
[18]Guo Xiaobo. Relationship between neutrophil lymphocyte ratio and prognosis in patients with renal cell carcinoma[J]. Journal of Changzhi Medical College,2016,30(2):121-124.[郭晓波.肾癌患者外周血中性粒细胞淋巴细胞比值与其预后的关系分析[J].长治医学院学报,2016,30(2):121-124.]
[19]Wang Liang,Tian Jie,Xu Yuejun,et al. Effect of retroperitoneal laparoscopic radical surgery on the immune function of patients with renal cell carcinoma[J]. Modern Biomedical Progress,2017,17(11):2110-2112.[王亮,田洁,许跃军,等.后腹腔镜根治术对肾癌患者免疫功能的影响[J].现代生物医学进展,2017,17(11):2110-2112.]
[2]Wang Shuhua,Liao Wenfeng,Lin Rui,et al. The relationship between the ratio of neutrophils to lymphocyte in peripheral blood and prognosis of renal cell carcinoma before operation[J]. Chinese Department of Urology,2015,36(11):812-817.[王书华,廖文峰,林瑞,等.术前外周血中性粒细胞与淋巴细胞的比值和肾癌预后的关系[J].中华泌尿外科杂志,2015,36(11):812-817.]
[3]Lamers CH,Sleijfer S,Steenbergen S,et al. Treatment of metastatic renal cell carcinoma with CAIX CAR-engineered T cells:clinical evaluation and management of on-target toxicity[J]. Mol Ther,2013,21(4):904-912.
[4]Liu XD,Hoang A,Zhou L,et al. Resistance to antiangiogenic therapy is associated with an immunosuppressive tumor microenvironment in metastatic renal cell carcinoma[J]. Cancer Immunol Res,2015,3(9):1017-1029.
[5]Yeh CR,Ou ZY,Xiao GQ,et al. Infiltrating T cells promote renal cell carcinoma(RCC)progression via altering the estrogen receptorβ-DAB2IP signals[J]. Oncotarget,2015,6(42):44346-44359.
[6]Yao Dayong,Shi Ce,Xia Shunyao,et al. Study on the relationship between the ratio of neutrophils/lymphocyte in peripheral blood and the clinicopathological features and prognosis of renal carcinoma[J]. Modern Biomedical Progress,2016,16(32):6379-6383,6209.[姚大勇,史策,夏舜尧,等.术前外周血中性粒细胞/淋巴细胞比值与肾癌临床病理特点及预后关系的研究[J].现代生物医学进展,2016,16(32):6379-6383,6209.]
[7]Yang L,Wu X,Wang D,et al. Renal carcinoma cell-derived exosomes induce human immortalized line of Jurkat T lymphocyte apoptosis in vitro[J]. Urol Int,2013,91(3):363-369.
[8]Guislain A,Gadiot J,Kaiser A,et al. Sunitinib pretreatment improves tumor-infiltrating lymphocyte expansion by reduction in intratumoral content of myeloid-derived suppressor cells in human renal cell carcinoma[J]. Cancer Immunol Immunother,2015,64(10):1241-1250.
[9]Zhang Jinchao,Yang Yanli,Sun Xuedong,et al. Effect analysis and follow-up observation of autologous dendritic cells combined with cytokine induced killer cells in the treatment of metastatic renal carcinoma[J]. Liberation Army Medical Journal,2016,41(10):827-832.[张金超,杨岩丽,孙雪冬,等.自体树突细胞联合细胞因子诱导的杀伤细胞治疗转移性肾癌的疗效分析及随访观察[J].解放军医学杂志,2016,41(10):827-832.]
[10]Kawashima H,Obayashi A,Kawamura M,et al. Galectin 9 and PINCH,novel immunotherapy targets of renal cell carcinoma:a rationale to find potential tumour antigens and the resulting cytotoxic T lymphocytes induced by the derived peptides[J]. BJU Int,2014,113(2):320-332.
[11]Zhang Li,Leng J,Yu Miao,et al. Effects of serum T lymphocyte subsets on the condition and survival of renal cell carcinoma[J].Clinical and Experimental Medicine,2017,16(19):1943-1945.[张莉,冷俊,郁淼,等.血清T淋巴细胞亚群对肾癌病情与生存状况的影响[J].临床和实验医学杂志,2017,16(19):1943-1945.]
[12]Weiss JM,Gregory Alvord W,Quinones OA,et al. CD40 expression in renal cell carcinoma is associated with tumor apoptosis,CD8(+)T cell frequency and patient survival[J]. Hum Immunol,2014,75(7):614-620.
[13]Han Xuebing,Chen Huiqing,Liu Jianwu,et al. Detection of immune function in patients with renal cell carcinoma before and after operation and its clinical significance[J]. Chinese Medicine and Clinic,2017,17(12):1749-1753.[韩雪冰,陈惠庆,刘建武,等.肾癌患者手术前后免疫功能检测及其临床意义[J].中国药物与临床,2017,17(12):1749-1753.]
[14]Ma Qingchang,Li Yanjiang,Zhao Zhenwei,et al. The prognostic significance of neutrophils,lymphocytes and their ratios to renal cell carcinoma[J]. Modern Oncology,2015,23(2):250-254.[马清昌,李延江,赵振威,等.中性粒、淋巴细胞及两者比值对肾癌的预后意义[J].现代肿瘤医学,2015,23(2):250-254.]
[15]Thiery-Vuillemin A,Laheurte C,Mansi L,et al. Immunomodulatory effects of everolimus in a long responsive patient with metastatic renal cell carcinoma[J]. J Immunother,2014,37(1):51-54.
[16]Meng FD,Sui CG,Tian X,et al. Heat-shock protein 70 as a tumor antigen for in vitro dendritic cell pulsing in renal cell carcinoma cases[J]. Asian Pac J Cancer Prev,2014,15(20):8947-8950.
[17]Wang Bingwei,Yang Guosheng,Fan Lixin,et al. Effect of retroperitoneoscopy on immune function and neuroendocrine function in patients with renal carcinoma[J]. Chinese Journal of Experimental Surgery,2014,31(6):1187-1189.[王炳卫,杨国胜,范立新,等.后腹腔镜手术对肾癌患者免疫功能及神经内分泌功能的影响[J].中华实验外科杂志,2014,31(6):1187-1189.]
[18]Guo Xiaobo. Relationship between neutrophil lymphocyte ratio and prognosis in patients with renal cell carcinoma[J]. Journal of Changzhi Medical College,2016,30(2):121-124.[郭晓波.肾癌患者外周血中性粒细胞淋巴细胞比值与其预后的关系分析[J].长治医学院学报,2016,30(2):121-124.]
[19]Wang Liang,Tian Jie,Xu Yuejun,et al. Effect of retroperitoneal laparoscopic radical surgery on the immune function of patients with renal cell carcinoma[J]. Modern Biomedical Progress,2017,17(11):2110-2112.[王亮,田洁,许跃军,等.后腹腔镜根治术对肾癌患者免疫功能的影响[J].现代生物医学进展,2017,17(11):2110-2112.]