紫杉醇对早期乳腺癌患者外周血淋巴细胞的影响
자삼순대조기유선암환자외주혈림파세포적영향
The effect of paclitaxel on the peripheral blood lymphocytes in early stage breast cancer
  • 万方数据
    中国癌症杂志 중국암증잡지
    CHINA ONCOLOGY
    2013年 9期 737-743 ,共7页

    桂安萍%凌飞海%郑书楷

    계안평%릉비해%정서해

    免疫%乳腺癌%淋巴细胞%化疗%紫杉醇 免疫%乳腺癌%淋巴細胞%化療%紫杉醇
    면역%유선암%림파세포%화료%자삼순
    Immunity%Breast cancer%Lymphocyte%Chemotherapy%Paclitaxel
    背景与目的：免疫功能是影响乳腺癌预后的重要因素之一。外周血及肿瘤内浸润的杀伤性T细胞计数能够预示乳腺癌的总生存率。另外，辅助化疗亦是提高术后乳腺癌患者无复发生存率及总生存率的重要环节。选择既对肿瘤细胞具有足够的杀伤作用，又能最大限度保留患者免疫功能的化疗药物对提高乳腺癌患者生存率具有重大意义。本研究旨在比较两种化疗方案，即蒽环类药物为主的CEF(环磷酰胺、表柔比星、5-氟尿嘧啶)方案以及蒽环类药物联合紫杉醇的EC序贯P(紫杉醇)方案对早期乳腺癌患者外周血淋巴细胞的影响。方法：回顾性分析自2012年11月-2013年5月在中山市人民医院乳腺外科行CEF方案(CEF组，n=20)或者EC序贯P方案(EC-P组，n=22)的早期乳腺癌术后患者的临床病理特征以及化疗前后患者外周血淋巴细胞的变化。关注的外周血淋巴细胞指标包括：总淋巴细胞计数以及T淋巴细胞、杀伤性T细胞、辅助性T细胞、活化T细胞和自然杀伤(NK)细胞的比例。结果：EC-P组患者较高危，临床分期、肿瘤大小、腋窝淋巴结状况、雌孕激素受体表达水平、组织分型等差异均有统计学意义(P＜0.05)。化疗前，两组患者的各项外周血淋巴细胞指标差异无统计学意义。化疗过程中，CEF组患者化疗4个及5个疗程后，外周血淋巴细胞总数分别为(1077±359)个/μL和(1181±271)个/μL，明显较化疗前[(1607±322)个/μL]减少，差异有统计学意义(P<0.05)。EC-P组患者化疗4个及5个疗程后，外周血淋巴细胞总数分别为(1500±312)个/μL和(1623±468)个/μ L，与化疗前[(1746±576)个/μL]比较，差异无统计学意义(P>0.05)。两组活化T细胞比例均随化疗疗程升高，CEF组化疗前(11.8±7.1)%，第5个疗程后(23±9.3)%，差异有统计学意义(P<0.05)；EC-P组化疗前(11.8±5.8)%，第5个疗程后(17.6±8.2)%，差异有统计学意义(P<0.05)。在EC-P组中，序贯使用1次紫杉醇后，辅助性T细胞比例为(37.8±5.7)%，较化疗前[(41.3±4.3)%]及使用紫杉醇前[(41.9±5.6)%]均显著下降(P<0.05)；NK细胞比例为(21.5±5.2)%，较化疗前[(15.3±7.6)%]及使用紫杉醇前[(14.9±5.9)%]均显著升高(P<0.01)。结论：相较于CEF方案，EC序贯P方案对术后乳腺癌患者的免疫功能影响较小。同时，紫杉醇能增加乳腺癌患者NK细胞比例，而不影响总T淋巴细胞及杀伤性T淋巴细胞比例，在保留早期乳腺癌患者抗肿瘤免疫功能方面具有优越性。
    배경여목적：면역공능시영향유선암예후적중요인소지일。외주혈급종류내침윤적살상성T세포계수능구예시유선암적총생존솔。령외，보조화료역시제고술후유선암환자무복발생존솔급총생존솔적중요배절。선택기대종류세포구유족구적살상작용，우능최대한도보류환자면역공능적화료약물대제고유선암환자생존솔구유중대의의。본연구지재비교량충화료방안，즉은배류약물위주적CEF(배린선알、표유비성、5-불뇨밀정)방안이급은배류약물연합자삼순적EC서관P(자삼순)방안대조기유선암환자외주혈림파세포적영향。방법：회고성분석자2012년11월-2013년5월재중산시인민의원유선외과행CEF방안(CEF조，n=20)혹자EC서관P방안(EC-P조，n=22)적조기유선암술후환자적림상병리특정이급화료전후환자외주혈림파세포적변화。관주적외주혈림파세포지표포괄：총림파세포계수이급T림파세포、살상성T세포、보조성T세포、활화T세포화자연살상(NK)세포적비례。결과：EC-P조환자교고위，림상분기、종류대소、액와림파결상황、자잉격소수체표체수평、조직분형등차이균유통계학의의(P＜0.05)。화료전，량조환자적각항외주혈림파세포지표차이무통계학의의。화료과정중，CEF조환자화료4개급5개료정후，외주혈림파세포총수분별위(1077±359)개/μL화(1181±271)개/μL，명현교화료전[(1607±322)개/μL]감소，차이유통계학의의(P<0.05)。EC-P조환자화료4개급5개료정후，외주혈림파세포총수분별위(1500±312)개/μL화(1623±468)개/μ L，여화료전[(1746±576)개/μL]비교，차이무통계학의의(P>0.05)。량조활화T세포비례균수화료료정승고，CEF조화료전(11.8±7.1)%，제5개료정후(23±9.3)%，차이유통계학의의(P<0.05)；EC-P조화료전(11.8±5.8)%，제5개료정후(17.6±8.2)%，차이유통계학의의(P<0.05)。재EC-P조중，서관사용1차자삼순후，보조성T세포비례위(37.8±5.7)%，교화료전[(41.3±4.3)%]급사용자삼순전[(41.9±5.6)%]균현저하강(P<0.05)；NK세포비례위(21.5±5.2)%，교화료전[(15.3±7.6)%]급사용자삼순전[(14.9±5.9)%]균현저승고(P<0.01)。결론：상교우CEF방안，EC서관P방안대술후유선암환자적면역공능영향교소。동시，자삼순능증가유선암환자NK세포비례，이불영향총T림파세포급살상성T림파세포비례，재보류조기유선암환자항종류면역공능방면구유우월성。
    Background and purpose:Immunity function is one of the most profound factors in affecting the prognosis of breast cancer patients. Cytotoxic T lymphocytes counts in the peripheral blood and focal tumor tissue could indicate the overall survival time of these patients. On the other hand, adjuvant chemotherapy is also an important part in improving both the disease free survival and overall survival time of breast cancer patients. Selecting chemotherapy regime which is both able to kill all the tumor cells and reserve the immunity function to the greatest extent is of great importance in improving the survival rate of breast cancer patients. The aim of this study was to compare the effect of two chemotherapy regimens CEF (cyclophosphamide, epirubicin and lfuorouracil) and EC followed by P (paclitaxel) on the peripheral blood lymphocytes in early stage breast cancer. Methods:The clinicopathological characteristics and peripheral blood lymphocyte parameters before and after chemotherapy of CEF or EC-P regimen were retrospectively analyzed in post-operate patients with early stage breast cancer during the period from Nov. 2012 to May 2013. The lymphocyte parameters included: total blood lymphocytes count, percentages of T lymphocytes, cytotoxic T lymphocytes, helper T lymphocytes, active T lymphocytes and nature killer (NK) cells. Results: Patients undertook EC-P regimen were those at comparably high risk (signiifcant differences of clinical stage, tumor size, axillary lymph node status, estrogen/progestogen receptor and histological subtype were observed). There was no difference of lymphocyte parameters between these two groups before adjuvant chemotherapy. However, during the process of chemotherapy, peripheral blood lymphocytes counts decreased signiifcantly after 4 and 5 cycles of chemotherapy of CEF regime (1 077±359/μL;1 181±271/μL) compared with the level before chemotherapy (1 607±322/μL, P<0.05). On the contrary, there was no signiifcant difference of peripheral blood lymphocytes count before (1 746±576/μL) and after 4 and 5 cycles of chemotherapy (1 500±312/μL;1 623±468/μL) in EC-P group (P>0.05). Percentage of active T lymphocyte increased signiifcantly along with the chemotherapy in both groups (CEF group:11.8±7.1 vs 23±9.3, P<0.05;EC-P group:11.8±5.8 vs 17.6±8.2, P<0.05) (pre-chemotherapy vs after 5 cycles of chemotherapy). In EC-P group, the percentage of helper T lymphocyte (37.8±5.7) decreased significantly compared with the levels before chemotherapy (41.3±4.3) and before paclitaxel was undertaken (41.9±5.6, P<0.05) and the percentage of NK cells (21.5±5.2) increased significantly compared with the levels before chemotherapy (15.3±7.6) and before paclitaxel was undertaken (14.9±5.9, P<0.01) after one cycle of paclitaxel therapy. Conclusion:The effect of chemotherapy on peripheral blood lymphocyte is less profound in EC-P group compared to CEF group. Furthermore, paclitaxel can increase the NK cells without any effect to the levels of T lymphocytes and cytotoxic T lymphocyte. It is superior over other drug in conserving immune function in early stage breast cancer.
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