南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (09): 1215-.

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非小细胞肺癌患者CD4+CD29+T细胞含量与复发及生存期的关系

李姝君，吴艳霞，陈华林，刘美莲，吴爱兵，杨志雄   

  • 出版日期:2016-09-20 发布日期:2016-09-20

Correlation of CD4+CD29+ regulatory T cells with recurrence and survival time in patients with non-small cell lung cancer

  • Online:2016-09-20 Published:2016-09-20

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摘要： 目的探讨CD4+CD29+T细胞在预测非小细胞肺癌（NSCLC）患者复发的作用，以及不同因素下的生存期差异。方法对59 例NSCLC进行为期5 年的随访，检测外周血CD4+CD29+T细胞含量，使用受试者工作特征曲线（ROC）评价该细胞预测复发 的敏感度及特异度，并与癌胚抗原（CEA）及细胞角蛋白21-1（Cyfra21-1）进行对比；使用Kaplan-Meier 法对不同性别、年龄 段、职业种类及是否放疗的NSCLC患者的生存情况进行分析。结果59 例NSCLC患者生存期最短为23 个月，最长随访期> 67 个月；共有19例复发，其中有17例在随访期内均死于肿瘤转移（28.81%）。未接受放疗患者及复发患者的CD4+CD29+T细胞 含量均分别显著高于放疗及无复发患者（均为P=0.000)。ROC分析显示曲线下面积（AUC）由大及小的顺序为CD4+CD29+T细 胞>Cyfra21-1>CEA（P=0.002、0.006 及0.013），95%可信区间(CI)分别为0.649~0.981、0.621~0.936 及0.584~0.944；当CD4+ CD29+T细胞百分含量为7.53 %，其预测复发的敏感度为91.42%，特异度为87.59%。以上59 例NSCLC患者的5 年生存率为 71.18%（42/59），Kaplan-Meier生存分析显示女性生存期长于男性（P=0.038），<50岁生存期长于>50岁（P=0.013），非脑力劳动者 生存期长于脑力劳动者（P=0.029），放疗患者生存期长于未放疗患者（P=0.003）。结论CD4+CD29+T细胞预测NSCLC复发的 效能优于Cyfra21-1及CEA；男性、大于55岁、从事脑力劳动、未行放射治疗是NSCLC的复发高危因素。

Abstract: Objective To investigate the correlation of CD4+CD29+ regulatory T cells (Treg) with tumor recurrence and survival time in patients with non-small cell lung cancer (NSCLC). Methods Fifty-nine patients with NSCLC treated with radical surgery were followed up for 5 years. Blood Treg cells were examined during the follow-up using flow cytometry (FCM). The sensitivity and specificity of Treg cells to predict recurrence of NSCLC were analyzed using receiver-operating characteristic (ROC) curve and compared with those of carcinoembryonic antigen (CEA) and cytokeratin21-1 (Cyfra21-1). The influences of gender, age, occupation and radiotherapy on survival time of the patients were analyzed with Kaplan-Meier method. Results Among the 59 patients, the shortest survival time was 23 months while the longest time was over 67 months. Nineteen patients had NSCLC recurrence, and 17 (28.81%) of them died of metastasis during the follow-up. The frequencies of blood Treg cells in patients who did not receive radiotherapy and in patients with tumor recurrence were significantly higher than those in patients receiving radiotherapy and in patients free of recurrence (P=0.000). ROC curves showed that the area under curve (AUC) lowered in the order of Treg cells, Cyfra21-1, CEA (P=0.002, 0.006 and 0.013, respectively) with 95% confidence interval (CI) of 0.649-0.981, 0.621-0.936 and 0.584-0.944, respectively. At the cut-off value of 7.53%, the sensitivity and specificity of Treg cells to predict NSCLC recurrence was 91.42% and 87.59%, respectively. The five-year survival rate of the 59 patients was 71.18% (42/59), and Kaplan-Meier analysis revealed a longer survival time in female patients (P=0.038), in patients below 50 years of age (P=0.013), in patients not engaging in mental work (P=0.029), and in patients receiving radiotherapy (P=0.003). Conclusion Treg cells has a better efficiency than Cyfra21-1 and CEA to predict tumor recurrence in patients with NSCLC following radical surgery. The male gender, an age beyond 50 years, an occupation of mental work, and failure to receive radiotherapy are all risk factors for recurrence of NSCLC.