Effects of Radiation Therapy Based on Pemetrexed Combination with Cisplation or Carboplatin Regimen on Peripheral Lymphocyte Subsets in Patients with Non-small Cell Lung Cancer
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摘要: 目的 探讨培美曲塞（pemetrexed）联合顺铂（cisplatin）或卡铂（carboplatin）治疗方案对非小细胞肺癌患者外周血淋巴细胞表型的影响。方法45例经病理学或细胞学确诊的非小细胞肺癌患者，采用培美曲塞500 mg/m2，第1天静脉滴注；顺铂25 mg/m2，第1～3天或卡铂按AUC=5计算剂量，第2天静脉滴注，21天为一周期，毎例患者至少治疗2周期，有可测量病灶者进行疗效评价。应用流式细胞仪检测化疗前和化疗后第7天外周血CD3+、CD4+、CD8+、CD16+56+、CD19+细胞的百分率和CD4+/CD8+比值。结果非小细胞肺癌患者经培美曲塞联合含铂方案化疗后CD4+、CD4+/CD8+、CD16+56+较化疗前升高（P=0.032），CD3+、CD8+、CD19+化疗前后差异无统计学意义（P>0.05）；临床分期为ⅢB～Ⅳ期的患者化疗前CD3+、CD4+、CD4+/CD8+和CD16+56+较ⅠB～ⅢA期患者低（P=0.029），化疗后两者比较差异无统计学意义（P>0.05）；化疗有效者CD3+、CD4+、CD4+/CD8+比值均显著增高（P=0.008）。结论非小细胞肺癌患者，尤其是晚期患者机体免疫功能低下。培美曲塞联合含铂方案化疗打破了原有的抗肿瘤免疫抑制状态，机体有可能通过免疫重建增强抗肿瘤免疫应答。Abstract: Objective To evaluate effects of radiation therapy based on pemetrexed combination with cisplatin or carboplatin regimen on the peripheral lymphocyte subsets in patients with non-small cell lung cancer(NSCLC). Methods A total of forty-five patients with a pathologic diagnosis enrolled in this study were treated with pemetrexed 500 mg/m2 infusion on day 1 and cisplatin 25 mg/m2 infusion on day 1 to 3 or carboplatin area under the curve(AUC)5 infusion on day 2.The peripheral blood was collected before and five days after chemotherapy.Every patient must be evaluated with the flow cytometry for CD3+,CD4+,CD8+,CD4+/CD8+,CD16+56+ and CD19+. Results The expressive rates of CD4+,CD16+56+ and CD4+/CD8+ in peripheral blood in post-treatment patients were higher than that in pre-treatment samples (P=0.032).No evident case of changes of CD3+,CD8+,and CD19+ positive cell percentage were observed after chemotherapy(P>0.05).Before chemotherapy,the positive percentage of CD3+,CD4+,CD16+56+ and the ratio of CD4+/CD8+ in NSCLC ⅢB～Ⅳ clinical stage were statistically significantly lower than those in ⅠB～ⅢA clinical stage patients（P=0.029）,but were not different from those after chemotherapy(P>0.05).CD3+,CD4+ and the ratio of CD4+/CD8+ in the effective group were highter than those in pre-treatment samples（P=0.008）. Conclusion The immune function of advanced stage NSCLC patients is evidently suppressed.Pemetrexed combination with cisplatin or carboplatin regimen for NSCLC may break up anti-tumor immune suppression,then a transient immune suppression condition is reversed by the body rebuilding to enhance the immune function.
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Key words:
- Pemetrexed /
- Non-small cell lung cancer /
- Lymphocyte subsets /
- Flow cytometry
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