标题：外周血T淋巴细胞亚群变化对乳腺癌新辅助化疗疗效的预测价值

      作者：刘刚 1，薛孝斌 2，任冬莉 3    西安市长安区医院肿瘤科 1、普通外科 2、麻醉科 3，陕西 西安 710100

      卷次： 2022年33卷7期

      【摘要】 目的 分析外周血T淋巴细胞亚群变化对乳腺癌新辅助化疗疗效的预测价值。方法 前瞻性选取2018年1月至2019年1月在西安市长安区医院进行新辅助化疗治疗的85例乳腺癌患者为观察组，另选取同期在我院体检的健康人群 44例作为对照组，比较两组受检者之间、乳腺癌不同临床病理特征患者之间的CD3+、CD4+、CD8+、CD4+/CD8+比值差异，并采用受试者操作特征曲线(ROC)计算曲线下面积(AUC)，分析CD3+、CD4+、CD8+、CD4+/CD8+对乳腺癌新辅助化疗疗效的预测价值。结果 观察组患者的 CD3 +、CD4+、CD4+/CD8+比值分别为(62.68±5.06)%、(28.55±4.39)%、0.87±0.28，明显低于对照组的(68.72±5.18)%、(36.66±4.62)%、1.37±0.33，CD8+为(32.77±4.32)%，明显高于对照组的(26.76±4.72)%，差异均有统计学意义(P<0.05)；TNM分期Ⅱ期患者的CD4+、CD4+/CD8+比值分别为(29.87±4.83)%、0.93±0.29，明显高于Ⅲ期患者的(26.99±4.26)%、0.81±0.25，差异均有统计学意义(P<0.05)；有淋巴结转移患者的CD4+、CD4+/CD8+比值分别为(30.23±4.70)%、0.95±0.30，明显高于无淋巴结转移患者的(27.31±4.42)%、0.82±0.27，差异均有统计学意义(P<0.05)；观察组患者治疗后的CD3+、CD4+、CD4+/CD8+比值分别为(65.96±5.50)%、(33.17±4.61)%、1.14±0.31，明显高于治疗前的(62.68±5.06)%、(28.55±4.39)%、0.87±0.28，CD8+为(29.11±4.05)%，明显低于治疗前的(32.77±4.32)%，差异均有统计学意义(P<0.05)；新辅助化疗后，疾病控制(DC)共57例，疾病进展(PD)28例。DC患者的CD3+、CD4+、CD4+/CD8+比值分别为(67.18±4.73)%、(35.28±4.57)%、1.23±0.35，明显高于 PD患者的(63.48±4.52)%、(28.87±4.33)%、0.96±0.32，差异均有统计学意义(P<0.05)，而DC患者的CD8+为(28.69±4.17)%，略低于PD患者的(29.97±4.35)%，但差异无统计学意义(P>0.05)；ROC曲线结果显示，CD3+、CD4+、CD4+/CD8+比值的截点值分别为67.90%、30.65%、31.03%、1.04，AUC分别为0.633、0.851、0.521、0.784，灵敏度分别为75.00%、75.00%、85.71%、82.14%，特异性分别为49.12%、84.21%、28.07%、77.19%。结论 乳腺癌患者T淋巴细胞比例显著降低，新辅助化疗可改善乳腺癌患者T淋巴细胞亚群免疫功能，其疗效与患者T淋巴细胞表达有关，CD4+和CD4+/CD8+比值可预测新辅助化疗的疗效。
      【关键词】 乳腺癌；外周血；T淋巴细胞亚群；化疗；疗效；预测
      【中图分类号】 R737.9 【文献标识码】 A 【文章编号】 1003—6350（2022）07—0864—05

Predictive value of changes of T lymphocyte subsets in peripheral blood on the efficacy of neoadjuvantchemotherapy for breast cancer.
LIU Gang 1, XUE Xiao-bin 2, REN Dong-li 3. Department of Oncology 1, Department ofGeneral Surgery 2, Department of Anesthesiology 3, Xi'an Chang'an District Hospital, Xi'an 710100, Shaanxi, CHINA
【Abstract】 Objective To analyze the predictive value of peripheral blood T lymphocyte subsets on the efficacyof neoadjuvant chemotherapy for breast cancer. Methods Eighty-five breast cancer patients who received neoadjuvantchemotherapy in Xi'an Chang'an District Hospital from January 2018 to January 2019 were prospectively selected as theobservation group, and 44 healthy people who underwent physical examination in the hospital during the same periodwere selected as the control group. CD3+, CD4+, CD8+, CD4+/CD8+ ratios were compared between the two groups and be-tween patients with different clinicopathological features of breast cancer. Area under the curve (AUC) was calculated byreceiver operating characteristic curve (ROC). The predictive value of CD3 + , CD4 + , CD8 + , CD4 +/CD8+ in neoadjuvantchemotherapy for breast cancer was analyzed. Results The ratios of CD3+, CD4+, CD4+/CD8+ in the observation groupwere (62.68±5.06)%, (28.55±4.39)%, 0.87±0.28, respectively, significantly lower than (68.72±5.18)%, (36.66±4.62)%,1.37±0.33 in the control group; CD8+ was (32.77±4.32)%, significantly higher than (26.76±4.72)% in the control group;the differences were statistically significant (P<0.05). The CD4+ and CD4+/CD8 + ratios of TNM stage Ⅱ patients were(29.87±4.83)% and 0.93±0.29, respectively, which were significantly higher than (26.99±4.26)% and 0.81±0.25 of TNMstage Ⅲ patients (P<0.05). The ratios of CD4 + and CD4 +/CD8 + in patients with lymph node metastasis were (30.23±4.70)% and 0.95±0.30, respectively, which were significantly higher than (27.31±4.42)% and 0.82±0.27 in patients with-out lymph node metastasis (P<0.05). After treatment, CD3 + , CD4 + , CD4 +/CD8 + ratio in the observation group were(65.96±5.50)%, (33.17±4.61)%, 1.14±0.31, respectively, significantly higher than (62.68±5.06)%, (28.55±4.39)%, 0.87±0.28 before treatment; CD8+ was (29.11±4.05)%, significantly lower than (32.77±4.32)% before treatment (P<0.05). Af-ter neoadjuvant chemotherapy, 57 patients had disease control (DC) and 28 patients had disease progression (PD). TheCD3+, CD4+, CD4+/CD8+ ratios in DC patients were (67.18±4.73)%, (35.28±4.57)%, 1.23±0.35, which were significantly