背景:本研究旨在探讨淋巴细胞亚群的预测能力,肌肉减少症和肌萎缩症对胃癌手术患者临床预后的影响。此外,我们探讨了CD3+/CD4+细胞与肌骨形成的预后意义.
方法:对2016年7月至2017年12月在我们机构接受手术并接受计算机断层扫描的190例胃癌患者进行了检查。所有患者均可获得完整的临床信息和外周血淋巴细胞亚群。采用了一系列全面的统计方法来仔细检查患者之间临床和病理特征的差异。目的是确定发展列线图所必需的自主预后决定因素。随后通过校准曲线分析对列线图的预测功效进行评估。
结果:该研究由190名参与者组成,包括126名男性(66.32%)和64名女性(33.68%),平均年龄58.47(±11.37)岁。根据CD3+/CD4+细胞和肌肉骨化症将患者分为三组,第1组24人,第2组87人,第3组79人。值得注意的是,第三组患者的无进展生存期(PFS)(风险比[HR]=0.208,P<0.001)和总生存期(OS)(HR=0.193,P<0.001)显著缩短.外周血淋巴细胞亚群表现出CD3+/CD4+细胞水平升高(HR=2.485,P<0.001)和CD4+/CD8+比值升高(HR=1.705,P=0.038),而CD19+细胞计数减少(HR=0.210,P=0.032)与患者OS改善相关。表现为肌肉减少症(HR=4.089,P=0.023)和肌萎缩症(HR=2.857,P<0.001)的个体显示出降低的OS。多因素Cox回归分析显示肿瘤淋巴结转移分期,CD19+细胞,肌少症和CD3+/CD4+细胞性肌骨病被确定为患者PFS和OS的独立预后因素。构建的PFS和OS的列线图得出的C指数值为0.839(95%置信区间[CI]:0.798-0.880)和0.836(95%CI:0.792-0.879),分别。校准分析表明,列线图准确预测了患者PFS和OS的3年和5年生存率。
结论:淋巴细胞亚群,包括CD3+/CD4+细胞,CD4+/CD8+比值和CD19+细胞,是胃癌手术患者的临床预后指标。身体成分参数,比如肌肉减少症和肌肉骨化症,也与患者的预后有关。CD3+/CD4+细胞与肌骨形成的组合显示出增强的预后价值,能够识别术后转移和复发风险高的患者。
BACKGROUND: This study aimed to investigate the predictive capacity of lymphocyte subpopulations, sarcopenia and
myosteatosis for clinical outcomes in patients who underwent gastric cancer surgery. Additionally, the prognostic significance of CD3+/CD4+ cells in conjunction with
myosteatosis was explored.
METHODS: A cohort of 190 patients with gastric cancer who underwent surgery and received computed tomography scans between July 2016 and December 2017 at our institution was examined. Complete clinical information and peripheral lymphocyte subpopulations were available for all patients. A comprehensive array of statistical methodologies was employed to scrutinize variances in both clinical and pathological characteristics among patients, with the aim of identifying autonomous prognostic determinants requisite for the development of a nomogram. Subsequent assessment of the predictive efficacy of the nomogram was conducted via calibration curve analysis.
RESULTS: The study comprised a cohort of 190 participants, encompassing 126 males (66.32%) and 64 females (33.68%), with a mean age of 58.47 (±11.37) years. Patients were stratified into three groups based on CD3+/CD4+ cells and
myosteatosis, with 24 in Group 1, 87 in Group 2 and 79 in Group 3. Notably, patients in the third group exhibited significantly shorter progression-free survival (PFS) (hazard ratio [HR] = 0.208, P < 0.001) and overall survival (OS) (HR = 0.193, P < 0.001). The subset of peripheral blood lymphocytes exhibited elevated levels of CD3+/CD4+ cells (HR = 2.485, P < 0.001) and heightened CD4+/CD8+ ratios (HR = 1.705, P = 0.038), whereas diminished CD19+ cell counts (HR = 0.210, P = 0.032) correlated with improved OS in patients. The individuals presenting with sarcopenia (HR = 4.089, P = 0.023) and
myosteatosis (HR = 2.857, P < 0.001) displayed reduced OS. The multivariate Cox regression analysis showed that pathological tumour-node-metastasis stage, CD19+ cells, sarcopenia and CD3+/CD4+ cell-myosteatosis were identified as independent prognostic factors for PFS and OS in patients. The constructed nomograms for PFS and OS yielded C-index values of 0.839 (95% confidence interval [CI]: 0.798-0.880) and 0.836 (95% CI: 0.792-0.879), respectively. The calibration analysis demonstrated that the nomograms accurately predicted the 3- and 5-year survival rates of PFS and OS in patients.
CONCLUSIONS: Lymphocyte subsets, including CD3+/CD4+ cells, CD4+/CD8+ ratio and CD19+ cells, are indicative of clinical prognosis in gastric cancer surgery patients. Body composition parameters, such as sarcopenia and myosteatosis, are also associated with the patient\'s prognosis. The combination of CD3+/CD4+ cells with
myosteatosis demonstrates enhanced prognostic value, enabling the identification of patients at high risk of post-operative metastasis and recurrence.