作者：吴芳华，龚超，陈魁，王力群

单位：福建医科大学附属福州市第一医院 普外科，福建 福州 350009

Authors:  WU Fanghua, GONG Chao, CHEN Kui, WANG Liqun

Unit:  Department of General Surgery, Fujian Medical University Affiliated Fuzhou First Hospital, Fuzhou 350009, Fujian, China

摘要：

目的   观察不同Lauren分型晚期胃癌患者外周血T淋巴细胞亚群的表达情况,分析免疫状态与不同Lauren分型晚期胃癌患者预后的相关性。方法  选取2014年6月至2017年6月初诊于我院普外科的108例晚期胃癌患者,采用流式细胞术检测外周血T淋巴细胞亚群CD4+T细胞、CD8+T细胞、调节性T细胞(Treg细胞)及自然杀伤(NK)细胞水平。根据受试者工作特征曲线(ROC)确定各免疫指标的最佳的截点值,分析免疫相关指标与不同Lauren分型晚期胃癌患者预后的相关性。结果  108例晚期胃癌患者中,肠型43例(39.81%)、弥漫型65例(60.19%)。ROC曲线分析显示,CD4+/CD8+比值、Treg细胞和NK细胞含量的最佳截点值分别为1.39、7.8%和19.9%。CD4+/CD8+比值及Treg细胞含量在不同Lauren分型间具有统计学差异(均P<0.05),而NK细胞含量在不同Lauren分型间的差异均无统计学意义(P>0.05)。外周血CD4+/CD8+比值、Treg细胞含量与弥漫型晚期胃癌患者OS相关(均P<0.05),且Treg细胞含量为弥漫型晚期胃癌患者OS的独立预后因素。而CD4+/CD8+比值、Treg细胞含量与肠型晚期胃癌患者OS无关(P>0.05)。NK细胞含量与以上2种Lauren分型晚期胃癌患者的OS均并无明显相关性(P>0.05)。结论  检测外周血T淋巴细胞亚群对了解不同Lauren分型晚期胃癌患者免疫功能状态有一定意义,外周血Treg细胞含量可有效预测弥漫型晚期胃癌者的预后。

关键词： 晚期胃癌; 免疫细胞; Lauren分型; 预后

Abstract：

Objective  To observe the expression of T lymphocyte subsets in peripheral blood of patients with stage IV gastric cancer in different Lauren classification, and to analyze the correlation between immune status and prognosis of patients with stage IV gastric cancer in different Lauren classification. Methods 108 patients with stage IV gastric cancer who were diagnosed in general surgery at our hospital from June 2014 to June 2017 were selected. Peripheral blood T lymphocyte subsets CD4+ T cells, CD8+ T cells, regulatory T cells (Treg cells) and natural killer (NK) cells were detected by flow cytometry. The optimal cut-off value of each immune index were determined according to the receiver operating characteristic curve (ROC), and the correlation between the immune-related index and the prognosis of patients with stage IV gastric cancer in different Lauren classification were analyzed. Results Of 108 patients with stage IV gastric cancer, 43 (39.81%) and 65 (60.19%) presented intestinal type and diffuse type gastric cancer, respectively. ROC curve analysis showed that the optimal cut-off values for CD4+/CD8+ ratio, Treg cells and NK cell content were 1.39, 7.8% and 19.9%, respectively. The CD4+/CD8+ ratio and Treg cell content were statistically different between different Lauren classifications (P<0.05), but there was no significant difference in NK cell content between different Lauren classifications (P>0.05). Peripheral blood CD4+/CD8+ ratio and Treg cell content were associated with OS in patients with diffuse stage IV gastric cancer (both P<0.05), and Treg cells were independent prognostic factors for OS in patients with diffuse stage IV gastric cancer. The ratio of CD4+/CD8+ and Treg cells were not associated with OS in patients with stage IV gastric cancer (P>0.05). There were no significant correlation between NK cell content and OS of the above two Lauren type patients with stage IV gastric cancer (P>0.05). Conclusion Detection of peripheral blood T lymphocyte subsets has a certain significance for understanding the immune function of patients with stage IV gastric cancer in different Lauren classification, and the peripheral blood Treg cells can effectively predict the prognosis of patients with diffuse stage IV gastric cancer.

Key Words:  Stage IV gastric cancer; Immune cells; Lauren type; Prognosis