Clinical value of peripheral regulatory cells in patients with non-small cell lung cancer undergoing radiotherapy / 中国肿瘤临床

ABSTRACT

Objective: To investigate the predictive value of peripheral regulatory T cells, NK cells, and T lymphocyte subsets in patients with non-small cell lung cancer (NSCLC) receiving radiotherapy. Methods: From January 2016 to December 2017, 105 patients with NSCLC and 45 healthy volunteers were enrolled in the study. Sixty-two patients were newly diagnosed, and 43 patients had relapsed. The lymphocyte subsets of patients with NSCLC were examined in fasting peripheral venous blood samples, and the influencing factors of progression-free survival were analyzed through univariate and multivariate analyses. Results: Compared with the healthy control group, the proportion of CD4+CD25+Foxp3+regulatory T cells in NSCLC patients was significantly higher (P<0.05); the high expression of CD4+CD25+Foxp3+regulatory T cells in recurrent NSCLC patients was further confirmed compared with the newly diagnosed patients. CD19+B cells, CD4+cells and the ratio of CD4/CD8 was significantly decreased and CD8+T cells as well as CD8+CD28-T cells were signifi-cantly increased in NSCLC patients (P<0.05). There was no significant difference in NK, NKT, γ&delta;T, CD3+, and CD8+CD28+T cells between patients and controls (P>0.05). In 40 patients with recurrence, the number of regulatory T cells increased compared with that in pa-tients with relapse, and the proportion of CD4+T cells and ratio of CD4/CD8 decreased. The difference was statistically significant (P<0.05). The high proportion of regulatory T cells was associated with progression-free survival [hazard ratio (HR)=2.55, 95% confidence interval (CI) 1.07 to 6.11, P=0.019]. There was no significant association between other lymphocyte subsets and progression-free sur-vival. In addition to lymphocyte subsets, the neutrophil/lymphocyte ratio was negatively correlated with progression-free survival (HR=2.66, 95%CI 1.01 to 7.05, P=0.033). There was a positive correlation between lymphocyte and progression-free survival (HR=0.42, 95% CI 0.17 to 1.03, P=0.042). According to clinicopathological features, the degree of tumor differentiation, T stage, and N stage in NSCLC patients were related to clinical prognosis (P<0.05). Multivariate analysis showed that the independent factors affecting progression-free survival were CD4+CD25+Foxp3+regulatory T cells and N stage (P<0.05). The proportion of regulatory T cells in patients with dis-ease progression was significantly higher than that in patients with stable disease, partial remission, and complete remission (P<0.05). The diagnostic efficacy of peripheral CD4+CD25+Foxp3+regulatory T cells in predicting progression-free survival in patients with NSCLC was analyzed using a receiver-operating characteristic curve (ROC) with an area under the curve of 0.915. When the optimal threshold was 2.85, the predictive sensitivity of peripheral CD4+CD25+Foxp3+regulatory T cells for progression-free survival in NSCLC patients was 87.7% and the specificity was 71.4%. Conclusions: CD4+CD25+Foxp3+regulatory T cells in crease in the peripheral blood of patients with NSCLC receiving radiotherapy and play as an independent factor in the progression of NSCLC. CD4+CD25+Foxp3+regulatory T cells can predict the prognosis of patients with NSCLC.