外周血淋巴细胞绝对计数在结直肠癌和食管癌肿瘤进展与治疗前后免疫状态评估的临床应用研究

目的通过回顾性分析结直肠癌和食管癌患者手术前后外周血T淋巴细胞和NK细胞数据，探讨免疫细胞绝对计数对于肿瘤患者疾病监测的临床价值。 方法回顾性分析我院64例结直肠癌和55例食管癌患者手术前后的外周血T淋巴细胞和NK细胞绝对计数与肿瘤病理结果、肿瘤分期的关系，以及动态变化表达结果。 结果(1)结直肠癌Ⅰ期到Ⅳ期患者术前外周血CD3⁺、CD3⁺CD4⁺、CD3⁺CD8⁺T淋巴细胞计数均逐渐增加，其中仅CD3⁺CD4⁺、CD3⁺CD8⁺T淋巴细胞数目变化具有统计学意义(P<0.05)。术后结直肠癌患者各淋巴细胞亚群计数在TNM分期间无显著性差异。(2)食管癌患者术前各TNM分期间的T淋巴细胞亚群计数未见显著差异(P>0.05)；术后食管癌患者CD3⁺、CD3⁺CD4⁺、CD3⁺CD8⁺T淋巴细胞计数在Ⅰ期和Ⅲ期均有显著性差异(P<0.05)，总体表现为随TNM分期，淋巴细胞计数升高。(3)结直肠癌患者术前外周T淋巴细胞亚群计数具有肿瘤分化程度越高其数目越低的趋势，且伴有淋巴结或远处转移患者的术前T细胞数目增加，NK细胞数目降低，但仅CD3⁺CD8⁺T细胞增加有统计学意义(P<0.05)；食管癌患者外周T淋巴细胞计数与肿瘤分化程度和肿瘤转移与否均无明显关系。(4)淋巴细胞计数的术前和术后动态分析显示，结直肠癌和食管癌患者外周T细胞亚群和NK细胞数目均表现为术后降低，随后逐渐增高趋势(P<0.05)。 结论结直肠癌与食管癌外周各淋巴细胞亚群计数在TNM分期、肿瘤分化程度及肿瘤转移与否间的临床表现不同；结直肠癌患者可能因机体高肿瘤负荷及低分化肿瘤促进机体免疫反应性T细胞亚群增殖，而抑制NK细胞增生；手术创伤可导致肿瘤患者机体的T淋巴细胞和NK细胞一过性降低。

Clinical study of peripheral T-lymphocyte subsets and NK cells in evaluating the progress of colorectal cancer and esophageal cancer and immune status before and after surgery therapy

ObjectiveTo explore the clinical value of absolute count of peripheral lymphocytes in monitoring immune status of cancer patients with surgery therapy, we retrospectively analyzed the absolute counts of peripheral T-lymphocytes subsets and NK cells before and after surgery in patients with colorectal cancer or esophageal cancer. MethodsRetrospectively analyzed the absolute counts of T lymphocytes and NK cells and the correlation between lymphocytes counts and tumor progression or pathological staging as well as dynamic characteristics of lymphocyte counts during perioperation in 64 cases of colorectal cancer and 55 cases of esophageal cancer with surgery therapy. Results(1) In patients with colorectal cancer, CD3⁺T lymphocytes, CD3⁺ CD4⁺ T lymphocytes and CD3⁺CD8⁺ T lymphocytes counts gradually increased from stageⅠto stageⅣ, but only CD3⁺CD4⁺ T lymphocytes and CD3⁺CD8⁺T lymphocytes increased significantly (P<0.05). No striking difference were found on the absolute counts of lymphocytes from stage Ⅰ to stageⅣafter surgery therapy. (2) In patients with esophageal cancer, the counts of preoperative T lymphocytes subsets in Ⅰ-Ⅳ stage has no significant difference (P>0.05); and the count of postoperative CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes gradually increased from stageⅠto stageⅢ (P<0.05). (3) In higher differentiated tumor lower preoperative counts of peripheral T lymphocytes existed in the patients with colorectal cancer (P>0.05). Patients with metastasis have more counts of T lymphocytes subsets and lower count of NK cells than that of patients without metastasis, and only CD3⁺CD8⁺T lymphocytes significantly increased (P<0.05). There was no association between peripheral T lymphocytes count and degree of tumor differentiation or tumor metastasis in patients with esophageal cancer. (4) Dynamic analysis of absolute counts of perioperative T lymphocyte subsets and NK cells showed that postoperative T lymphocytes and NK cells firstly strikingly decreased (P<0.05), then increased (P<0.05). ConclusionsThe correlation of peripheral T lymphocytes or NK cells count with TNM staging, degree of tumor differentiation as well as tumor metastasis was not the same between colorectal cancer and esophageal cancer. In patients with colorectal cancer the responsively increasing preoperative T lymphocytes counts and suppression of preoperative NK cells may be caused by high tumor burden and poorly differentiated tumor; surgery trauma could cause transiently decrease of postoperative T lymphocytes and NK cells.