身体剂量参数对局部晚期鼻咽癌患者免疫细胞减少的影响分析：一项回顾性队列研究

江健韵; 翟瑞萍; 应红梅

doi:10.19401/j.cnki.1007-3639.2023.10.002

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身体剂量参数对局部晚期鼻咽癌患者免疫细胞减少的影响分析：一项回顾性队列研究

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- 身体剂量参数对局部晚期鼻咽癌患者免疫细胞减少的影响分析：一项回顾性队列研究
- Impact of body dose parameters on circulating immune cells in locally advanced nasopharyngeal carcinoma patients: a retrospective cohort study
- 中国癌症杂志 2023年33卷第10期页码：898-907
- 作者机构：
  
  1. 复旦大学附属肿瘤医院放射治疗中心，复旦大学上海医学院肿瘤学系，上海 200032
  2. 上海市放射肿瘤学重点实验室，上海 200032
  3. 上海市放射治疗临床医学研究中心，上海 200032
- 作者简介：
  
  [ "江健韵（ORCID: 0000-0002-3137-8597），硕士研究生。" ]
  应红梅（ORCID: 0000-0003-2642-3135），主任医师，硕士研究生导师，复旦大学附属肿瘤医院放疗中心头颈专科主任。
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.10.002
  中图分类号： R739.62；R739.63
- 收稿：2023-06-12，
  
  修回：2023-09-19，
  
  纸质出版：2023-10-30
- 稿件说明：
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江健韵, 翟瑞萍, 应红梅. 身体剂量参数对局部晚期鼻咽癌患者免疫细胞减少的影响分析：一项回顾性队列研究[J]. 中国癌症杂志, 2023,33(10):898-907.

Jianyun JIANG, Ruiping ZHAI, Hongmei YING. Impact of body dose parameters on circulating immune cells in locally advanced nasopharyngeal carcinoma patients: a retrospective cohort study[J]. China Oncology, 2023, 33(10): 898-907.
江健韵, 翟瑞萍, 应红梅. 身体剂量参数对局部晚期鼻咽癌患者免疫细胞减少的影响分析：一项回顾性队列研究[J]. 中国癌症杂志, 2023,33(10):898-907. DOI： 10.19401/j.cnki.1007-3639.2023.10.002.

Jianyun JIANG, Ruiping ZHAI, Hongmei YING. Impact of body dose parameters on circulating immune cells in locally advanced nasopharyngeal carcinoma patients: a retrospective cohort study[J]. China Oncology, 2023, 33(10): 898-907. DOI： 10.19401/j.cnki.1007-3639.2023.10.002.

摘要

背景与目的：

调强适形放疗（intensity-modulated radiotherapy，IMRT）可显著提升局部晚期鼻咽癌患者的生存结局，然而该疗法仍未能满足局部晚期鼻咽癌（locally-advanced nasopharyngeal carcinoma，LANPC）患者的预后需求，因此，确定有效的预后预测标志物对于改善放疗的效果和实现个体化治疗至关重要。由于放疗相关的身体剂量参数和免疫炎性标志物在以往的研究中显示出潜在的预测价值，本研究旨在探讨局部晚期鼻咽癌患者放疗过程中身体剂量参数与免疫细胞减少及预后之间的关系。

方法：

回顾性分析了2012年1月1日—2016年12月31日在复旦大学附属肿瘤医院接受根治性放疗的423例LANPC患者（Ⅲ ~ Ⅳa期）的临床资料，研究IMRT期间多种免疫细胞的百分比变化范围。采用Cox比例风险回归模型来确定患者总生存（overall survival，OS）、局部无复发生存（locoregional relapse-free survival，LRFS）和无远处转移生存（distant metastasis-free survival，DMFS）的独立预后因素。从剂量-体积直方图（dose-volume diagrams，DVH）中获取一系列身体剂量参数（body dose parameters），采用logistic回归确定与白细胞变化相关的影响因素。

结果：

较高的淋巴细胞变化范围[ΔLYM%≥77.0%（high ΔLYM%）

]

和较高的单核细胞变化范围[ΔMONO%≥28.5%（high ΔMONO%）

]

是局部晚期鼻咽癌患者的两个不良预后因素。多因素分析结果显示，high ΔLYM%被证明是OS（HR = 1.672，

= 0.012）、LRFS（HR = 1.712，

= 0.006）和DMFS（HR = 1.971，

= 0.001）的不良预后因素；High ΔMONO%可作为OS（HR = 1.355，

= 0.015）和DMFS（HR = 1.704，

= 0.003）的不良预后因素。ΔLYM%变化值受身体剂量参数中的身体辐照总剂量（integral body dose，IBD）（OR = 1.004，

= 0.037）和body V

（OR = 1.046，

= 0.036）的影响，而ΔMONO%受body V

（OR = 1.144，

= 0.009）和V

（OR = 0.734，

= 0.022）的影响。

结论：

IBD、body V

和body V

、V

可作为放疗计划中的剂量限制区域，以减轻对淋巴细胞和单核细胞的消耗，进一步改善预后。

Abstract

Background and purpose:

The implementation of intensity-modulated radiotherapy (IMRT) has significantly enhanced the survival outcomes for patients with nasopharyngeal carcinoma (NPC). However

this therapeutic approach still falls short in meeting the prognostic requirements of individuals with locally advanced NPC (LANPC). Therefore

it is imperative

to identify effective prognostic markers to enhance the efficacy of radiotherapy and achieve personalized treatment. Given the potential predictive value demonstrated in previous studies regarding radiotherapy-related body dose parameters and immune blood cells

this study aimed to investigate the correlation between body dose parameters and reduced immune cells and patient prognosis during radiotherapy in LANPC patients.

Methods:

Clinical data of 423 patients with LANPC (stage Ⅲ-Ⅳa) treated in Fudan University Shanghai Cancer Center from Jan.1

2012 to Dec. 31

2016 were retrospectively analyzed. Percentage changes of different immune blood cells during radiotherapy were also collected. Cox proportional hazard model was used to determine prognostic factors for overall survival (OS)

locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS). Body dose-based parameters were extracted from dose-volume histograms (DVHs). Logistic regression was applied to determine parameters that could predict white blood cells reduction.

Results:

High ΔLYM% (ΔLYM%≥7 7.0%) and high ΔMONO% (ΔMONO%≥2 8.5%) were identified as two adverse prognostic factors in LANPC patients. In multivariable analysis

high ΔLYM% was found to be a significant predictor of worse OS (HR = 1.672

= 0.012)

LRFS (HR = 1.712

= 0.006)

and DMFS (HR = 1.971

= 0.001). High ΔMONO% was associated with worse OS (HR = 1.355

= 0.015) and DMFS (HR = 1.704

= 0.003). The change of ΔLYM% was influenced by the integral body dose (IBD) (OR = 1.004

= 0.037) and body V

(OR = 1.046

= 0.036). ΔMONO% was significantly affected by body V

(OR = 1.144

= 0.009) and V

(OR = 0.734

= 0.022).

Conclusion:

Integral body dose

and V

can serve as dose-volume co

nstraints to retain sufficient immune cell populations to improve prognosis.

关键词

Keywords

references

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