上皮性卵巢癌患者外周血T淋巴细胞水平和病理参数对预后的预测价值

doi:10.11958/20250354

摘要/Abstract

摘要：

目的探讨上皮性卵巢癌（OC）患者外周血T淋巴细胞水平变化并分析其与病理参数的关联性和对患者预后的预测价值。方法选取上皮性OC患者60例为病例组，另选卵巢良性肿瘤患者85例作为良性组；病例组患者均接受腹腔镜手术治疗，术后均随访3年，根据预后情况分为预后良好组（32例）和预后不良组（28例）。检测受试者外周血CD3⁺、CD4⁺、CD8⁺水平，并计算CD4⁺/CD8⁺比值；对比不同临床病理特征上皮性OC患者外周血T淋巴细胞水平；绘制受试者工作特征（ROC）曲线分析外周血T淋巴细胞对上皮性OC患者预后的预测价值。结果与良性组比较，病例组外周血CD3⁺、CD4⁺、CD4⁺/CD8⁺水平降低，CD8⁺水平升高（P<0.05）。与Ⅰ—Ⅱ期、高分化、无腹腔积液、无淋巴结转移的上皮性OC患者比较，Ⅲ—Ⅳ期、中低分化、有腹腔积液、有淋巴结转移的上皮性OC患者外周血CD3⁺、CD4⁺水平更低，而CD8⁺更高（P<0.05）。与预后良好组比较，预后不良组外周血CD3⁺、CD4⁺水平更低，而CD8⁺更高（P<0.05）。ROC分析显示，CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺联合检测预测上皮性OC患者预后的曲线下面积（AUC）为0.952，高于各指标单独检测的AUC（P<0.05）。结论外周血T淋巴细胞水平与上皮性OC患者临床病理特征和预后有关，各指标联合检测预测上皮性OC患者预后更具优势。

关键词: 卵巢肿瘤, T淋巴细胞, 预后, 病理特征, 预测价值

Abstract:

Objective To investigate the changes in peripheral blood T-lymphocyte levels in patients with epithelial ovarian cancer (OC), and to analyze their relationship with patients' pathological parameters and their predictive value for patients' prognosis. Methods A total of 60 epithelial OC patients were selected as the case group, and 85 benign ovarian tumor patients were selected as the benign group. All patients in the case group received laparoscopic surgery and were followed up for 3 years. According to the prognosis, patients were divided into the good prognosis group (n=32) and the poor prognosis group (n=28). The peripheral blood levels of CD3⁺, CD4⁺ and CD8⁺ were detected, and the ratio of CD4⁺/CD8⁺ was calculated. The peripheral blood levels of T lymphocytes in epithelial OC patients with different clinicopathological characteristics were compared. Receiver operating characteristic curve (ROC) was drawn to analyze the prognostic value of peripheral blood T lymphocytes in patients with epithelial OC. Results Compared with the benign group, the peripheral blood levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ were decreased in the case group, and the CD8⁺ level was increased (P<0.05). Compared with epithelial OC patients with stage Ⅰ-Ⅱ, high differentiation, no peritoneal effusion and no lymph node metastasis, the peripheral blood CD3⁺ and CD4⁺ levels in epithelial OC patients with stage Ⅲ-Ⅳ, moderate and low differentiation, with peritoneal effusion and lymph node metastasis were lower, while CD8⁺ was higher (P<0.05). Compared with the good prognosis group, the peripheral blood levels of CD3⁺ and CD4⁺ were lower in the poor prognosis group, while the CD8⁺level was higher (P<0.05). ROC analysis showed that the area under the curve (AUC) of combined detection of CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ to predict the prognosis of epithelial OC patients was 0.952, which was higher than that of single detection of CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ (P<0.05). Conclusion Peripheral blood T-lymphocyte levels are correlated with clinicopathological characteristics and prognosis of patients with epithelial OC, and the combined testing of each index is more advantageous in predicting the prognosis of patients with epithelial OC.

Key words: ovarian neoplasms, T-lymphocytes, prognosis, pathological characteristics, predictive value

中图分类号:

R737.31

图/表 6

参考文献 18

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组别	n	年龄/岁	BMI/（kg/m²）	妊娠史	妊娠次数/次
良性组	85	40.22±5.91	23.23±1.09	81（95.29）	2.72±0.65
病例组	60	40.20±6.01	23.18±1.12	57（95.00）	2.67±0.66
t或χ²		0.023	0.277	0.007	0.465

组别	n	年龄/岁	BMI/（kg/m²）	妊娠史	妊娠次数/次
良性组	85	40.22±5.91	23.23±1.09	81（95.29）	2.72±0.65
病例组	60	40.20±6.01	23.18±1.12	57（95.00）	2.67±0.66
t或χ²		0.023	0.277	0.007	0.465

组别	n	CD3⁺/%	CD4⁺/%	CD8⁺/%	CD4⁺/CD8⁺
良性组	85	62.38±3.39	39.25±2.67	21.22±1.34	1.86±0.17
病例组	60	53.12±1.56	26.58±1.72	27.12±3.10	0.99±0.14
t		19.729^＊＊	32.329^＊＊	15.581^＊＊	32.423^＊＊

组别	n	CD3⁺/%	CD4⁺/%	CD8⁺/%	CD4⁺/CD8⁺
良性组	85	62.38±3.39	39.25±2.67	21.22±1.34	1.86±0.17
病例组	60	53.12±1.56	26.58±1.72	27.12±3.10	0.99±0.14
t		19.729^＊＊	32.329^＊＊	15.581^＊＊	32.423^＊＊

病理特征	n	CD3⁺/%	t	CD4⁺/%	t	CD8⁺/%	t	CD4⁺/CD8⁺	t
肿瘤分期
Ⅰ—Ⅱ期	25	54.13±1.61	5.007^＊＊	28.18±1.05	9.909^＊＊	24.53±2.74	7.670^＊＊	1.01±0.17	1.014
Ⅲ—Ⅳ期	35	52.41±1.05	5.007^＊＊	25.44±1.06	9.909^＊＊	28.96±1.73	7.670^＊＊	0.98±0.12	1.014
分化程度
中低分化	28	52.54±1.13	2.879^＊＊	25.82±0.98	3.491^＊＊	28.63±1.84	3.927^＊＊	0.96±0.11	1.510
高分化	32	53.63±1.71	2.879^＊＊	27.25±1.95	3.491^＊＊	25.80±3.40	3.927^＊＊	1.02±0.16	1.510
腹腔积液
有	34	52.66±1.38	2.796^＊＊	26.05±1.31	2.933^＊＊	28.15±2.42	3.166^＊＊	1.00±0.12	0.072
无	26	53.73±1.59	2.796^＊＊	27.28±1.95	2.933^＊＊	25.77±3.41	3.166^＊＊	0.99±0.17	0.072
淋巴结转移
有	35	52.53±1.21	3.881^＊＊	25.88±1.51	4.290^＊＊	28.69±2.34	5.897^＊＊	0.99±0.12	0.316
无	25	53.95±1.63	3.881^＊＊	27.57±1.50	4.290^＊＊	24.91±2.69	5.897^＊＊	1.00±0.17	0.316