南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (8): 1270-1276.doi: 10.12122/j.issn.1673-4254.2021.08.21

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新辅助同步放化疗对直肠癌微环境浸润免疫细胞的影响

杨 群，周春香，韩 宸，张 颖，蒋玉娜，李镇江，马进安   

  1. 中南大学湘雅二医院临床护理学教研室，肿瘤科，胃肠外科，湖南 长沙 410011
  • 出版日期:2021-08-20 发布日期:2021-09-07

Effects of neoadjuvant chemoradiotherapy on infiltrating immune cells in the tumor microenvironment of rectal cancer

YANG Qun, ZHOU Chunxiang, HAN Chen, ZHANG Ying, JIANG Yuna, LI Zhenjiang, MA Jinan   

  1. Clinical Nursing Teaching and Research Section, Department of Oncology, Department of Gastrointestinal Surgery, Xiangya Second Hospital of Central South University, Changsha 410011, China
  • Online:2021-08-20 Published:2021-09-07

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摘要： 目的 检测新辅助同步放化疗（CRT）前后直肠癌组织中肿瘤浸润免疫细胞数量和表型的变化，并分析它们与患者临床病理参数之间的相关性。方法 采用免疫组织化学染色ElivisionTM Plus法，检测20例直肠癌患者新辅助CRT前后的活检标本和术后病理标本组织中CD3、CD4、CD8、CD56、Foxp3蛋白的表达水平。结果 新辅助CRT后直肠癌肿瘤组织中CD3（21.8% vs 48.8%，P<0.001）、CD4（16.5% vs 42.2%，P<0.001）、CD8（8.3% vs 33.4%，P<0.001）和CD56（0 vs 7.6%，P=0.012）的表达均较前升高；Foxp3（26.0% vs 15.3%，P=0.005）表达较前下降；CD4/CD8（2.7 vs 5.1）比值较前无明显变化。多因素分析显示新辅助CRT后CD3（HR= 0.16，P=0.028）、CD8（HR= 0.03，P=0.001）阳性细胞的增加与患者术后无复发生存期正相关。结论 直肠癌新辅助CRT后肿瘤组织中CD3、CD4、CD8、CD56阳性浸润免疫细胞比例较治疗前明显增加，Treg淋巴细胞比例则明显下降，CD3、CD8阳性T淋巴细胞数量增加的患者其术后无复发生存期延长。

关键词: 直肠癌；新辅助同步放化疗；肿瘤浸润免疫细胞；免疫组织化学；预后

Abstract: Objective To detect the changes in the number and phenotype of tumor infiltrating immune cells in rectal cancer tissues before and after neoadjuvant concurrent chemoradiotherapy (CRT) and analyze their correlation with the clinicopathological parameters of the patients. Methods The protein expressions of CD3, CD4, CD8, CD56 and Foxp3 in biopsy specimens and postoperative pathological specimens collected from 20 rectal cancer patients before and after neoadjuvant CRT were detected using ElivisionTM Plus immunohistochemistry, and the results were statistically analyzed. Results Compared with the measurements before the therapy, neoadjuvant CRT resulted in significant increments in CD3 (21.8% vs 48.8% , P< 0.001), CD4 (16.5% vs 42.2%, P<0.001), CD8 (8.3% vs 33.4%, P<0.001) and CD56 (0 vs 7.6%, P=0.012), obvious reduction in Foxp3 expression (26.0% vs 15.3%, P=0.005), but no significant changes in CD4/CD8 ratio of (2.7 vs 5.1). Multivariate analysis showed that the increase of CD3- positive cells (HR=0.16, P=0.028) and CD8- positive cells (HR=0.03, P=0.001) was positively correlated with the disease-free survival of the patients after the operation. Conclusion Neoadjuvant CRT can significantly increase the proportions of infiltrating immune cells positive for CD3, CD4, CD8 and CD56 and decrease the proportion of Treg lymphocytes in the tumor tissues in patients with rectal cancer. The patients with increased CD3- and CD8- positive T lymphocytes may have longer disease-free survival after the surgery

Key words: rectal cancer; neoadjuvant concurrent chemoradiotherapy; tumor infiltrating immune cells; immunohistochemistry; prognosis