早期化疗对乳腺癌根治术后患者免疫功能的影响及疗效
摘要
目的探讨早期化疗对乳腺癌根治术后患者免疫功能的影响及临床疗效。方法选取2014年1月至2015年1月南阳市第一人民医院收治的行乳腺癌根治术后进行单纯化疗的患者96例,根据术后辅助化疗开始时间将患者分为观察组与对照组,每组48例,观察组术后2周内开始化疗,对照组术后2～6周内开始化疗。比较两组化疗期间不良反应(皮肤反应、骨髓抑制、胃肠道反应)发生率及化疗结束1个月后,CD4~+、CD8~+T细胞阳性率及CD4~+/CD8~+T细胞比值,并随访3年观察其无进展期生存率、生存质量。结果化疗开始前,两组患者CD4~+、CD8~+T细胞阳性率及CD4~+/CD8~+T细胞比值差异无统计学意义(P>0.05);化疗结束后,观察组CD4~+水平高于对照组(68.26%比56.48%),而CD8~+水平低于对照组(21.28%比26.63%),观察组CD4~+/CD8~+比值高于对照组(2.14比1.35),差异均有统计学意义(P<0.05);且两组各项免疫指标治疗前、后差值比较均有统计学意义(P<0.05)。观察组化疗期间皮肤反应、骨髓抑制、胃肠道反应的发生率与对照组相比,差异无统计学意义(P>0.05)。观察组无进展期生存率为79.17%,对照组为60.41%,差异有统计学意义(P<0.05)。观察组化疗后SF-36各维度评分均高于对照组,差异有统计学意义(P<0.05)。结论早期化疗能改善乳腺癌根治术后患者的免疫功能,并有效提高患者术后无进展期生存率及生活质量。
引文
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[2]FISHER B,SAFFER E,RUDOCK C,et al.Effect of local or systemic treatment prior to primary tumor removal on the production and response to a serum growth-stimulating factor in mice[J].CancerRes,1989,49(8):2002-2004.
[3]GIORDANO S H,ELIAS A D,GRADISHAR W J.NCCNguidelines updates:breast cancer[J].J Natl Compr Canc Netw,2018,16(5S):605-610.
[4]中国女医师协会临床肿瘤学专业委员会.中国进展期乳腺癌共识指南(CABC 2015)[J].癌症进展,2015,4(3):223-245.
[5]RAPHAEL M J,BIAGI J J,KONG W,et al.The relationship between time to initiation of adjuvant chemotherapy and survival in breast cancer:a systematic review and meta-analysis[J].Breast Cancer Res Treat,2016,160(1):17-28.
[6]HERSHMAN D L,WANG X,MCBRIDE R,et al.Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women[J].Breast Cancer Res Treat,2006,99(3):313-321.
[7]孙桂香,李齐岳.小儿恶性肿瘤诊断与治疗[M].北京:北京医科大学中国协和医科大学联合出版社,1994:78-79.
[8]REN X S,RD A B,ZHOU L,et al.Translation and psychometric evaluation of a Chinese version of the SF-36health survey in the United States[J].J Clin Epidemiol,1998,51(11):1129-1138.
[9]LEE H S,KIM J S,CHOI I J,et al.The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction[J].Cancer,2015,79(11):2087-2094.
[10]CHO Y,MIYAMOTO M,KATO K,et al.CD4+and CD8+Tcells cooperate to improve prognosis of patients with esophageal squamous cell carcinoma[J].CancerRes,2003,63(7):1555-1559.
[11]SEWELL H F,HALBER C F,ROBIN R A,et al.Chmotherapy-induced differential changes in lymphocyte subsets and naturalkiller-cell function in patients with advanced breast cancer[J].Int J Cancer,1993,55(5):735-738.
[12]刘明放,李云霞,尹清云.化疗对晚期乳腺癌患者免疫功能的影响[J].实用医学杂志,2002,18(2):157-158.
[13]郭文利,黄建棋,陆建菊.乳腺癌根治术后早期化疗对患者临床预后的影响[J].中国普通外科杂志,2017,26(5):666-670.
[14]李朝辉,周立中.乳腺癌术后辅助化疗开始时间与预后相关性研究[J].中国医学工程,2011,19(6):22-25.
[15]WANG W,BELOSAY A,YANG X,et al.Effects of letrozole on breast cancer micro-metastatic tumor growth in bone and lung in mice inoculated with murine 4T1 cells[J].Clin Exp Metastasis,2016,33(5):475-485.