早期宫颈癌患者术后外周血淋巴细胞计数变化的临床意义

发布时间：2018-12-25 09:14

【摘要】：背景：宫颈癌是全球女性生殖系统常见的恶性肿瘤之一,其发病率仅次于乳腺癌。国家癌症中心和卫生部公布的《2012年中国肿瘤登记年报》登记新发病例约12.96/10万,占女性恶性肿瘤的5.12%,位于女性恶性肿瘤发病第7位。其中城市发病率为13.35/10万,农村发病率为12.14/10万。众所周知肿瘤的发生发展与肿瘤宿主的免疫状态密切相关,恶性肿瘤患者机体的免疫功能均有不同程度的紊乱,机体免疫功能与肿瘤的发生、发展、转移、疗效及预后有密切关系。当宿主免疫功能低下或受抑制时,肿瘤发病率增高；而在肿瘤进行性生长时,肿瘤患者的免疫功能受抑制,两者互为因果,双方各因素的消长对于肿瘤的发生发展与预后具有重要的影响。而淋巴细胞作为机体免疫应答功能的重要组成部分,在抗肿瘤免疫反应中发挥了关键作用。目前国外已有相关文献报道外周血淋巴细胞计数可作为某些恶性肿瘤的独立预后因素,而国内无此类报道,故我们对早期宫颈癌患者术后外周血淋巴细胞计数变化进行了研究,分析外周血淋巴细胞计数与早期宫颈癌患者预后的临床意义,为以后的临床预后评估提供一种新的思维方式。目的：本文对四川省肿瘤医院妇瘤科2008年5月到2012年12月接受经腹Ⅲ型广泛子宫切除术、临床资料和随访资料完善的IB1和ⅡAl早期宫颈癌术后123名患者进行回顾性分析,评估外周血淋巴细胞计数变化对于早期宫颈癌术后患者的预后价值。方法：收集123例在四川省肿瘤医院2008年5月到2012年12月接受经腹Ⅲ型广泛子宫切除术、临床资料和随访资料完善的IB1和IIA1早期宫颈癌术后患者对其进行回顾性分析。患者年龄30岁-66岁,中位年龄43岁；随访5个月-61个月,中位随访时间为25个月,所有患者均在术前1周及术后第3天、第7天抽取静脉血送查血常规。影响预后的因素,单因素分析采用Log-rank检验,多因素分析采用cox回归模型。分析淋巴细胞计数变化与预后的关系。结果：纳入研究组患者共123例,患者年龄30岁-66岁,中位年龄43岁；随访5个月-61个月,中位随访时间为25个月。临床分期：IB1期109例,Ⅱal期14例。病理类型：鳞癌99例,非鳞癌24例。1 3例复发或转移(复发率10.6%),5例死亡(死亡率4.07%)。术后单纯化疗21例,以铂类为基础的同步放化疗73例,未行放化疗29例(其中自行放弃放化疗14例)。患者术前外周血淋巴细胞计数均值为1.56×109/L。术后第三天外周血淋巴细胞计数呈下降趋势,术后第3日淋巴细胞均值为1.16×109/L；术后第7日外周血淋巴细胞计数有所恢复、均值为1.33×109/L,但仍未能达到术前水平。单因素分析显示：术前外周血低淋巴细胞计数(P=0.012)、术后淋巴结转移(P=0.001)和宫旁浸润(P=0.013)与早期宫颈癌患者术后无进展生存率有关。多因素分析显示：术前淋巴细胞计数[风险比(HR)：6.08795%CI：1.743-21.251 P=0.005]和淋巴结转移(HR：5.98495%CI：1.803-19.802P=0.003)是影响术后无进展生存率的独立危险因素。结论：术前外周血低淋巴细胞计数和淋巴结转移是影响术后无进展生存率的独立危险因素。外周血淋巴细胞计数对早期宫颈癌术后患者的预后有一定的预测价值。
[Abstract]:BACKGROUND: Cervical cancer is one of the most common malignant tumors in the female reproductive system of the world. The National Cancer Center and the Ministry of Health, published by the Ministry of Health, published the Annual Report on the Registration of Cancer in China in 2012. The number of newly-registered new cases is about 1296/ 100,000, accounting for 5.12% of the female malignant tumor, and is located in the 7th place of the female malignant tumor. The incidence of the city is 13.35/ 100,000, and the rural incidence rate is 12. 14/ 10 million. It is well known that the development of the tumor is closely related to the immune state of the tumor host, and the immune function of the body of the malignant tumor patient has different degree of disorder, and the immune function of the body is closely related to the occurrence, development, metastasis, curative effect and prognosis of the tumor. when the host immune function is low or is inhibited, the incidence of the tumor is increased; and when the tumor is progressive growth, the immune function of the tumor patient is inhibited, the two are mutually cause and effect, and the fluctuation of each factor of the two parties has an important influence on the occurrence and the prognosis of the tumor. As an important part of the immune response, lymphocytes play a key role in the anti-tumor immune response. The number of peripheral blood lymphocytes in peripheral blood of patients with early cervical cancer has been studied. To analyze the clinical significance of peripheral blood lymphocyte count and the prognosis of early cervical cancer patients, and to provide a new way of thinking for future clinical outcome evaluation. Objective: In this paper, 123 patients with IB1 and 鈪l early cervical cancer who underwent extensive hysterectomy, clinical data and follow-up data from May 2008 to December 2012 were analyzed retrospectively. To assess the prognostic value of peripheral blood lymphocyte count changes in patients with early cervical cancer. Methods: 123 patients with early cervical carcinoma of IB1 and IIA1 from May 2008 to December 2012 in Sichuan Cancer Hospital were retrospectively analyzed. The age of the patient was 30-66 years, the middle-level was 43 years, the follow-up period was 5 months to 61 months, the median follow-up time was 25 months, and all the patients were collected from the venous blood at the first week of the operation and the third day after the operation. Log-rank test was used for single-factor analysis, and cox regression model was used for multi-factor analysis. The relationship between lymphocyte count change and prognosis was analyzed. Results: A total of 123 patients were enrolled in the study group. The age of the patients was 30 to 66 years. The median age was 43 years. The follow-up period was 5 months to 61 months, and the median follow-up time was 25 months. Clinical stages: 109 cases of IB1 and 14 cases of 鈪l phase. There were 99 cases of squamous cell carcinoma, 24 cases of non-squamous cell carcinoma, 1 case of recurrence or metastasis (recurrence rate of 10. 6%) and 5 cases of death (death rate of 4.07%). There were 21 cases of simple chemotherapy after operation, 73 cases of concurrent chemoradiotherapy based on the platinum group, and 29 cases of non-radiotherapy and chemotherapy (in which 14 cases of chemoradiotherapy were discarded). The mean value of the peripheral blood lymphocyte count was 1.56-109/ L in the pre-operative peripheral blood. On the third day of the operation, the peripheral blood lymphocyte count decreased, and the mean value of the lymphocytes in the third day after the operation was 1. 16-109/ L. The peripheral blood lymphocyte count was recovered on the 7th day after the operation, and the mean value was 1. 33-109/ L, but the pre-operative level was still not reached. The single factor analysis showed that the peripheral blood lymphocyte count (P = 0.012), the postoperative lymph node metastasis (P = 0.001) and the lateral invasion of the uterus (P = 0.013) were related to the non-progression-free survival rate in the early stage of cervical cancer. Multi-factor analysis showed that the pre-operative lymphocyte count[hazard ratio (HR): 6.08795% CI: 1.743-21. 251P = 0. 005] and lymph node metastasis (HR: 5.98495% CI: 1.803-19.802P = 0.003) were independent risk factors that affect the postoperative progression-free survival. Conclusion: The low lymphocyte count and lymph node metastasis in the pre-operative peripheral blood are independent risk factors that affect the non-progression-free survival rate. Peripheral blood lymphocyte count has a certain value for predicting the prognosis of patients with early cervical cancer.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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