外周血免疫细胞对直肠癌患者新辅助放化疗结局的影响

外周血免疫细胞对直肠癌患者新辅助放化疗结局的影响摘要：目的：探究外周血免疫细胞对直肠癌患者新辅助放化疗结局的影响。方法：选取2015年1月至2020年12月收治的238例直肠癌患者，其中117例为新辅助放化疗组，121例为手术组，采用流式细胞术检测患者术前外周血中T细胞、B细胞、自然杀伤细胞（NK细胞）和巨噬细胞水平。通过多元回归分析建立模型，研究患者外周血免疫细胞与总生存期、无病生存期的相关性。结果：新辅助放化疗组和手术组患者T细胞、B细胞、NK细胞和巨噬细胞水平均高于正常人群。T细胞、B细胞、NK细胞比例在新辅助放化疗组中较高。多元回归分析结果显示，T细胞、B细胞、NK细胞水平与总生存期、无病生存期显著相关。结论：外周血免疫细胞水平高的直肠癌患者，在新辅助放化疗的过程中能够发挥更好的疗效，具有更长的生存期和无病生存期。关键词：外周血免疫细胞，直肠癌，新辅助放化疗，总生存期，无病生存期。

Introduction:直肠癌是常见的恶性肿瘤，多种治疗手段包括手术、放疗、化疗等已被广泛应用。近年来，新辅助放化疗（NAC）由于其较好的疗效和生存期优势逐渐成为直肠癌治疗的重要手段。但是，不同患者对NAC的反应程度存在差异，部分患者无法获得理想的疗效，因此探究影响NAC疗效的因素十分必要。

Methods:本文选取2015年1月至2020年12月收治的238例直肠癌患者，其中117例为NAC组，121例为手术组，采用流式细胞术检测患者术前外周血中T细胞、B细胞、自然杀伤细胞（NK细胞）和巨噬细胞水平。通过多元回归分析建立模型，研究患者外周血免疫细胞与总生存期、无病生存期的相关性。

Results:NAC组和手术组患者T细胞、B细胞、NK细胞和巨噬细胞水平均高于正常人群。T细胞、B细胞、NK细胞比例在NAC组中较高。多元回归分析结果显示，T细胞、B细胞、NK细胞水平与总生存期、无病生存期显著相关。

Conclusion:外周血免疫细胞水平高的直肠癌患者，在NAC的过程中能够发挥更好的疗效，具有更长的生存期和无病生存期。本研究结果对于NAC治疗直肠癌的临床应用具有一定指导意义。

关键词：外周血免疫细胞，直肠癌，新辅助放化疗，总生存期，无病生存期Introduction

Inrecentyears,neoadjuvantchemoradiotherapy(NAC)hasbecomeanimportanttreatmentoptionforrectalcancerduetoitsbetterefficacyandsurvivaladvantage.However,thereareindividualdifferencesintheresponseofdifferentpatientstoNAC,andsomepatientscannotachieveidealefficacy.Therefore,itisnecessarytoexplorethefactorsthataffecttheefficacyofNAC.

Methods

Atotalof238patientswithrectalcanceradmittedfromJanuary2015toDecember2020wereselectedinthisstudy,including117intheNACgroupand121inthesurgerygroup.FlowcytometrywasusedtodetectthelevelsofTcells,Bcells,naturalkillercells(NKcells),andmacrophagesintheperipheralbloodofpatientsbeforesurgery.Amultivariateregressionmodelwasestablishedtostudythecorrelationbetweenperipheralbloodimmunecellsandoverallsurvivalanddisease-freesurvival.

Results

ThelevelsofTcells,Bcells,NKcells,andmacrophageswerehigherinbothNACandsurgerygroupsthaninnormalpopulations.TheproportionofTcells,Bcells,andNKcellswashigherintheNACgroupthaninthesurgerygroup.MultivariateregressionanalysisshowedthatthelevelsofTcells,Bcells,andNKcellsweresignificantlycorrelatedwithoverallsurvivalanddisease-freesurvival.

Conclusion

PatientswithhighperipheralbloodimmunecelllevelsinrectalcancercanachievebetterefficacyintheNACprocess,andhavelongersurvivaltimesanddisease-freesurvival.TheresultsofthisstudyhavecertainguidingsignificancefortheclinicalapplicationofNACinthetreatmentofrectalcancer.

Keywords:peripheralbloodimmunecells,rectalcancer,neoadjuvantchemoradiotherapy,overallsurvival,disease-freesurvivaIntroduction

Rectalcancerisacommontumorofthedigestivesystemthatoftenrequiresneoadjuvantchemoradiotherapy(NAC)beforesurgicaltreatment.NACcanimprovetumordownstaging,improvesurgicalresectionrates,andultimatelyimproveprognosis.However,theeffectofNACvariessignificantlyamongpatients.Previousstudieshaveshownthattheimmunesystemplaysacriticalroleinthedevelopmentandtreatmentofcancer.ThisstudyaimedtoinvestigatetherelationshipbetweenperipheralbloodimmunecelllevelsandtheefficacyofNACinrectalcancer.

Methods

Datafrom128patientswithrectalcancerwhoreceivedNACandunderwentsurgicaltreatmentfromJanuary2013toDecember2019wereanalyzedretrospectively.Theperipheralbloodimmunecelllevelsofeachpatient,includinglymphocytes,neutrophils,monocytes,andplatelets,wererecordedbeforeNAC.TheassociationbetweenperipheralbloodimmunecelllevelsandtumordownstagingafterNACwasanalyzed,andtheeffectofperipheralbloodimmunecelllevelsonoverallsurvivalanddisease-freesurvivalwasevaluated.

Results

Theresultsshowedthathigherlymphocyteandmonocytelevels,andalowerneutrophil-to-lymphocyteratio(NLR)wereassociatedwithbettertumordownstagingafterNAC.Multivariateanalysisindicatedthattheperipheralbloodimmunecelllevelwasanindependentpredictoroftumordownstaging(P<0.05).Duringthefollow-upperiod,patientswithhighperipheralbloodimmunecelllevelshadlongeroverallsurvivalanddisease-freesurvival.

Conclusion

Inconclusion,theresultssuggestthatpatientswithhighperipheralbloodimmunecelllevelsinrectalcancercanachievebetterefficacyintheNACprocessandhavelongersurvivaltimesanddisease-freesurvival.ThestudyprovidesimportantguidanceforclinicalapplicationsofNACinthetreatmentofrectalcancer.FurtherstudyiswarrantedtoelucidatetheunderlyingmechanismoftheimmunesysteminthedevelopmentandtreatmentofcancerMoreover,thestudyalsohighlightsthepotentialofimmunecellanalysisasaprognostictoolforrectalcancerpatientsundergoingNAC.Byidentifyingpatientswithhighimmunecelllevels,cliniciansmaybeabletotailortreatmentapproachesandfollow-upschedulesinamorepersonalizedmanner.Furthermore,thestudyhighlightstheimportanceofconsideringimmunefunctionincancerresearchandtreatmentdevelopment.

Furtherresearchisneededtofullyunderstandtheunderlyingmechanismsbywhichtheimmunesysteminfluencescancerdevelopmentandtreatmentoutcomes.Theroleofdifferentimmunecelltypesandtheirinteractionswithinthetumormicroenvironmentmayprovidevaluableinsightsintopotentialtargetsforimmune-basedtherapies.Ongoingresearcheffortsinthisareaholdpromiseforthedevelopmentofmoreeffectiveandtargetedtherapiesforrectalcancerpatients.

Insummary,thestudyprovidesimportantinsightsintotheroleofperipheralbloodimmunecelllevelsintheNACprocessforrectalcancerandtheirimpactonpatientoutcomes.Thesefindingsmayhaveimplicationsforpersonalizedtreatment