CAJ | 학술논문

目的：探讨调节性T细胞（Tregs）和CD8+T细胞在黏膜恶性黑色素瘤和肢端恶性黑色素瘤局部免疫微环境中表达情况的差异，及其与患者预后的关系。方法采用免疫组织化学染色法对58例恶性黑色素瘤组织进行染色，检测Foxp3+Tregs和CD8+T细胞的浸润情况，分析两者与临床病理指标及预后的相关性。结果 Foxp3与CD8+T细胞阳性表达无相关关系。黏膜恶性黑色素瘤组织中Foxp3+Tregs数量明显高于肢端恶性黑色素瘤（t=2.648，P=0.011）；肿瘤直径≥3 cm、有淋巴结转移、有远处转移的恶黑患者Foxp3highTregs相对较高（P＜0.05）。存在溃疡的恶性黑色素瘤患者中，CD8high组所占比例明显高于无溃疡者（33.3%vs 5.9%，P＜0.05）。Foxp3high组的中位无进展生存期（PFS）是12个月，明显低于Foxp3low组（31个月）；CD8high组的中位PFS是25个月，明显高于CD8low组（中位PFS 12个月）；亚组分析显示Foxp3high CD8low组患者中位PFS是7个月，明显低于Foxp3highCD8high组（25个月）、Foxp3lowCD8low组（18个月）以及Foxp3low CD8high组（59个月）。不同肿瘤位置、Foxp3+Treg数量、CD8+T细胞数量、有无远处转移的恶性黑色素瘤患者中位PFS不同。结论 Tregs的数量与恶性黑色素瘤的进展密切相关，黏膜恶性黑色素瘤预后欠佳可能与Tregs浸润有关。
목적：탐토조절성T세포（Tregs）화CD8+T세포재점막악성흑색소류화지단악성흑색소류국부면역미배경중표체정황적차이，급기여환자예후적관계。방법채용면역조직화학염색법대58례악성흑색소류조직진행염색，검측Foxp3+Tregs화CD8+T세포적침윤정황，분석량자여림상병리지표급예후적상관성。결과 Foxp3여CD8+T세포양성표체무상관관계。점막악성흑색소류조직중Foxp3+Tregs수량명현고우지단악성흑색소류（t=2.648，P=0.011）；종류직경≥3 cm、유림파결전이、유원처전이적악흑환자Foxp3highTregs상대교고（P＜0.05）。존재궤양적악성흑색소류환자중，CD8high조소점비례명현고우무궤양자（33.3%vs 5.9%，P＜0.05）。Foxp3high조적중위무진전생존기（PFS）시12개월，명현저우Foxp3low조（31개월）；CD8high조적중위PFS시25개월，명현고우CD8low조（중위PFS 12개월）；아조분석현시Foxp3high CD8low조환자중위PFS시7개월，명현저우Foxp3highCD8high조（25개월）、Foxp3lowCD8low조（18개월）이급Foxp3low CD8high조（59개월）。불동종류위치、Foxp3+Treg수량、CD8+T세포수량、유무원처전이적악성흑색소류환자중위PFS불동。결론 Tregs적수량여악성흑색소류적진전밀절상관，점막악성흑색소류예후흠가가능여Tregs침윤유관。
Objective To investigate the different distribution of regulatory T cells (Tregs) and CD8+T cells in the local immune microenvironment of mucosal malignant melanoma and cutaneous malignant melanoma, and analyze the relationship between the two indicators and the prognosis of patients. Methods Immunohistochemistry staining was used to assess the ex?pression of Foxp3+Tregs and CD8+T cells in tumor microenvironment of 58 patients with malignant melanoma. The correlation between two factors, clinicopathological characteristics, and prognosis were analyzed. Results There is no correlation be?tween the expression of Foxp3 and CD8. The number of Foxp3+Tregs was significantly higher in mucosa malignant melanoma than that in cutaneous malignant melanoma (t=2.648, P=0.011). The proportion of Foxp3highTregs was significantly higher in pa?tients with tumor diameter≥3 cm, lymph node metastasis and distant metastasis than that in patients with tumor diameter<3 cm, no lymph node metastasis and no distant metastasis (P<0.05). In addition, in patients with ulceration that proportion was significantly higher in CD8high group than that in patients without ulceration (33.3%vs 5.9%, P<0.05). The median progres?sion-free surial (PFS) was 12 months in Foxp3high group, which was significantly longer than that of Foxp3low group (31 months, P<0.05). The median PFS was significantly higher in CD8high group (25 months) than that of CD8low group (12 months, P<0.05). Subgroup analysis showed that the median PFS was 7 months in Foxp3high CD8low group, which was significantly lower than that of Foxp3highCD8high group (25 months) and Foxp3lowCD8low group (18 months, P=0.003). Univariate analysis showed that median PFS was different in patients with different tumor location, different number of Foxp3+Treg, different number of CD8+T cells, and distant metastases. Conclusion The number of Tregs is closely associated with metastasis in patients with malig?nant melanoma. Compared with cutaneous malignant melanoma, our results indicate that the poor prognosis of mucosal malig?nant melanoma may be associated with the infiltration of more Tregs.