外周血T淋巴细胞亚群及早期炎症标志物表达对老年非小细胞肺癌化疗预后的影响分析

目的评估外周血T淋巴细胞亚群及早期炎症标志物表达对老年非小细胞肺癌(NSCLC)化疗预后的影响。方法入选2015年1月至2018年12月在武汉科技大学附属孝感医院接受化疗的NSCLC患者86例为NSCLC组,另选本院常规体检的健康人群82名作为对照组,分析两组人群外周血T淋巴细胞亚群与炎症细胞的分布差异。采用Kaplan-Meier单因素生存分析不同临床参数及化疗后不同T细胞亚群和炎症细胞水平患者的生存期,采用Cox比例回归风险模型分析影响NSCLC患者预后的独立影响因素。结果与对照组比较,NSCLC组患者CD3^+(71.31±6.02比68.22±7.09)、CD4^+(40.20±5.79比36.61±7.11)、CD4^+/CD8+(1.49±0.37比1.30±0.56),CD8+(28.43±6.37比31.79±9.88)均降低,而PLT(229.73±58.84比211.32±54.18)、淋巴细胞计数(LY)(1.67±0.61比30.01±8.45)及淋巴细胞百分比(LY﹪)(25.65﹪±6.87﹪比30.01﹪±8.45﹪)均升高,差异具有统计学意义(P均<0.05)。Kaplan-Meier单因素生存分析结果显示,是否淋巴转移、远处转移及不同TNM分期的患者生存期相比,差异具有统计学意义(P均<0.05);CD8+T细胞≥31.8﹪、CD4/CD8<1.28、中性粒细胞与淋巴细胞比值(NLR)<3.16及血小板与淋巴细胞比值(PLR)<197的患者生存期较长,差异具有统计学意义(P均<0.05);Cox多因素生存分析结果显示,伴远处转移(HR=9.310)、TNM分期ⅢB-Ⅳ期(HR=1.059)、CD8+T细胞<31.8﹪(HR=2.697)、NLR≥3.16(HR=1.887)及PLR≥197(HR=2.869)是影响老年NSCLC患者预后的独立影响因素(P均<0.05)。结论外周血CD8+T细胞、CD4/CD8比值、NLR及PLR水平是影响老年NSCLC预后的独立影响因素,可作为评估老年NSCLC患者化疗预后的简易生物标志物。

Relationship between peripheral blood T lymphocyte subsets early inflammatory markers and the prognosis in elderly patients with non-small cell lung cancer after chemotherapy

ObjectiveTo evaluate the effect of T lymphocyte subsets and early inflammatory markers on the prognosis of elderly patients with non-small cell lung cancer (NSCLC) after chemotherapy. Methods86 elderly patients with non-small cell lung cancer received chemotherapy in our hospital from January 2015 to December 2018 and 82 healthy people were selected as control group. The distribution differences of T lymphocyte subsets and inflammatory cells in peripheral blood between NSCLC patients and control group were analyzed. Kaplan-Meier univariate survival analysis was performedto analyze the survival of paitents, and Cox proportional regression risk model was used to analyze the independent factors affecting the prognosis of NSCLC patients. ResultsCompared with the control group, the level of CD3⁺ (71.31±6.02 vs 68.22±7.09) , CD4⁺ (40.20±5.79 vs 36.61±7.11) , CD4⁺/ CD8⁺ (1.49±0.37 vs 1.30±0.56) , and CD8⁺ (28.43±6.37 vs 31.79±9.88) were significantly lower in NSCLC patients, while the level of PLT (229.73±58.84 vs 211.32±54.18) , absolute lymphocyte value (LY) (1.67±0.61 vs 30.01±8.45) , and percentage of lymphocyte (LY ﹪) (25.65 ﹪± 6.87 ﹪ vs 30.01 ﹪± 8.45 ﹪) were higher (t = 3.038, 3.579, 2.582, 2.606, 2.107, 3.608, 3.659, P < 0.05) . The patients with CD8⁺ T cells ≥ 31.8﹪, CD4 / CD8 < 1.28, NLR < 3.16 and PLR < 197 have longer survival time than those with TNM (P < 0.05) . In addition, the results of Cox analysis showed that distant metastasis (HR = 9.310) , TNM stage IIIB-IV (HR =1.059) , CD8⁺ T cell < 31.8﹪, NLR ≥ 3.16 (HR = 1.887) and PLR ≥ 197 (HR = 2.869) were independent factors of prognosis inelderly NSCLC patients (P < 0.05) . ConclusionPeripheral blood CD8⁺ T cells, CD4 / CD8 ratio, NLR and PLR levels are independent factors of prognosis inelderly patients with NSCLC, and could be used as a simple biomarker to evaluate the prognosis of elderly patients with NSCLC after chemotherapy.