通过淋巴细胞亚群计数和癌症中的免疫因子来评估免疫状态。本研究分析了颅内生殖细胞肿瘤(iGCT)患者的外周血免疫指标和生存结局。
外周血淋巴细胞亚群计数和白细胞介素(IL)-2,IL-4,IL-6,IL-10,肿瘤坏死因子(TNF)的水平,收集并回顾性分析133例iGCT患者的干扰素-γ(IFN)。他们的临床信息是从医院数据库中提取的,并通过电话访视证实预后。患者(n=11)进行了前瞻性审查,并对其外周血淋巴细胞样本进行了验证。
共有113名(84.2%)患者接受综合治疗,包括96种标准治疗(包括或不包括手术的全程化疗和放射学联合治疗)和17种全面但非标准治疗(不包括全程化疗或非标准放疗)和98种(73.7%)达到完全或部分缓解.T淋巴细胞(CD3+),细胞毒性T细胞(CD3+CD8+或Tc),和B淋巴细胞(CD19+)减少(p=0.047,p=0.004,和p<0.001,分别),而活化的细胞毒性T淋巴细胞(CD8+CD25+)和IFN在治疗后增加(分别为p<0.001和p=0.002)。中位生存期为45.33个月,Tc细胞和激活的Tc细胞以及IFN增加的患者表现出令人鼓舞的结果(分别为p=0.039,p=0.041和p=0.017)。回归分析显示未升高的Tc细胞和未升高的活化Tc细胞是不良预后的独立因素(p=0.016,HR=3.96,95CI=1.288~12.20;p=0.002,HR=4.37,95CI=1.738~10.97)。标准放化疗与降低死亡风险独立相关(p=0.022,HR=0.19,95CI=0.044-0.79)。在通过回顾性和前瞻性研究建立的列线图中可以看出一致性。免疫风险模型表明,活化组(活化T细胞和IFN水平均升高)预后最好,IFN水平升高的轻度激活型具有中间结果,沉默免疫状态的患者结局最差(Logrank检验,p=0.011)。
实施标准综合治疗导致积极的反应。动态监测外周血淋巴细胞亚群可作为判断预后的辅助指标。
Immune status was evaluated by means of lymphocyte subset counts and immune factors in cancer. This study analyzed the peripheral blood immune index and survival outcomes in intracranial germ cell tumor (iGCT) patients.
Peripheral blood lymphocyte subset counts and levels of interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF), and interferon-γ (IFN) from 133 iGCT patients were collected and retrospectively analyzed. Their clinical information was extracted from the hospital database, and prognosis was confirmed by telephone visit. Patients (n=11) underwent prospective review and their samples of peripheral blood lymphocytes were verified.
A total of 113 (84.2%) patients received comprehensive treatments, including 96 standard therapy (combination of full course chemotherapy and radiology with or without surgery) and 17 comprehensive but non-standard therapy (either without full course chemotherapy or with non-standard radiotherapy) and 98 (73.7%) reached complete or partial response. T lymphocytes (CD3+), cytotoxic T cells (CD3+CD8+ or Tc), and B lymphocytes (CD19+) decreased (p=0.047, p=0.004, and p<0.001, respectively), while activated cytotoxic T lymphocytes (CD8+CD25+) and IFN increased (p<0.001 and p=0.002, respectively) after treatment. Median survival was 45.33 months, and patients with increased Tc cells and activated Tc cells as well as IFN presented encouraging outcomes (p=0.039, p=0.041, and p=0.017 respectively). Regression analysis showed that non-increased Tc cells and non-increased activated Tc cells were independent factors of poor prognosis (p=0.016, HR=3.96, 95%CI=1.288-12.20; p=0.002, HR=4.37 95%CI= 1.738-10.97). Standard chemo-radiotherapy was independently related to reduced risk of death(p=0.022, HR=0.19, 95%CI=0.044-0.79). Consistence was seen in a nomogram established through retro and prospective studies. An immune risk model indicated the activated group (with both increased activated T cells and IFN levels) had the best prognosis, the mildly activated type with elevated IFN levels had intermediate outcome, and patients with the silent immune status had the worst outcomes (Log rank test, p=0.011).
Implementation of standard comprehensive treatments led to positive responses. Dynamic monitoring of peripheral blood lymphocyte subsets can be used as an auxiliary indicator for prognosis judgment.