NSCLC围放疗期淋巴细胞亚群变化对无疾病进展生存期的影响

Effect of Lymphocyte Subsets Variation on Progression-Free Survival of NSCLC during Peri-Radiotherapy Period

摘要: 目的：探索不同放疗方式淋巴细胞亚群的变化及对无疾病进展生存的影响。方法：选取2019年2月至2019年10月于我院行放疗的原发性非小细胞肺癌(Non-Small Cell Lung Cancer, NSCLC)患者共45例，分为静态调强(IMRT)、动态调强(VMAT)两组；于放疗前1周内、放疗剂量至40 Gy时行外周血淋巴细胞及亚群检验；记录两组患者放疗计划参数；对患者进行随访至疾病进展。采用SPSS26.0进行统计学分析。结果：1) 淋巴细胞亚群变化：外周血淋巴细胞总数、CD3+T淋巴细胞亚群、CD3+CD4+T淋巴细胞亚群、CD4+/CD8+比值两组放疗后均减低，VMAT组下降幅度更大。两组比较淋巴细胞总数无统计学差异(P > 0.05)，CD3+T淋巴细胞亚群有统计学差异(P < 0.05)，CD3+CD4+T淋巴细胞亚群、CD4+/CD8+比值有显著统计学差异(P < 0.01)；CD3+CD8+T淋巴细胞亚群两组放疗后均升高，VMAT组上升更明显，差异无统计学差异(P > 0.05)。2) 放疗参数：IMRT与VMAT比较，PTV体积无统计学差异(P > 0.05)；双肺V5、V10、V20、V30 VMAT组受量更高(P < 0.05)；双肺平均剂量(MLD)、靶区剂量均匀性、适形度指数VMAT组更好(P < 0.05)。3) PFS生存分析发现，两组患者无进展生存时间比较无统计学差异(P > 0.05)。结论：1) NSCLC患者IMRT、VMAT两种放疗方式均引起外周血淋巴细胞减少及淋巴细胞亚群再分布，VAMT组更明显；2) NSCLC患者两种放疗方式的双肺危及器官受量低剂量存在差异，VMAT组更高；双肺平均剂量、靶区剂量均匀性、适形度指数VMAT组更优；3) IMRT、VMAT两种不同的放疗方式下，两组患者无疾病进展生存期无明显差异。

Abstract: Objective: The objective is to explore the variation of lymphocyte subsets between Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Radiotherapy (VMAT), and the effect of the variation on Progression-Free Survival in patients with primary NSCLC(non-small cell lung cancer). Methods: A total of 45 patients who received radiotherapy (RT) in the radiotherapy department of our hospital from February 2019 to October 2019 were enrolled and divided into IMRT group and VMAT group. The peripheral blood lymphocyte and subgroup tests were performed at 1 week before RT and when the RT dose was up to 40 Gy. RT planning parameters of two groups were recorded. Patients were followed up for disease progression. SPSS26.0 was used for statistical analysis. Results: 1) Lymphocyte and subsets parameters: the total number of peripheral blood lymphocytes, CD3+T lymphocyte subsets, CD3+CD4+T lymphocyte subsets, CD4+/CD8+ ratio decreased, and significantly decreased in VMAT group. Comparison between groups: peripheral blood lymphocytes (P > 0.05), CD3+T lymphocyte subsets (P < 0.05), and there was significant difference in CD3+CD4+T lymphocyte subsets, CD4+/CD8+ ratio, P < 0.01. The CD3+CD8+T lymphocyte subsets increased and were more obvious in VMAT group (P > 0.05). 2) RT parameters: there was no statistical difference in PTV volume between the two groups (P > 0.05). V5, V10, V20 and V30 VMAT groups received higher doses (P < 0.05). Mean lung dose (MLD), Homogeneity Index (HI) and Conformity Index (CI) are better in VMAT group (P < 0.05). 3) PFS analysis showed that there was no difference between the two groups (P > 0.05). Conclusions: 1) Lymphocytopenia and redistribution of lymphocyte subsets in peripheral blood of patients with NSCLC were induced by different RT methods, especially in the VAMT group; 2) There are differences in the low-dose region of the double lung organs at risk in different radiotherapy modalities of IMRT and VMAT for NSCLC, which is higher in VMAT group. The mean lung dose (MLD), Homogeneity Index (HI) and Conformity Index (CI) are better in VMAT group; 3) There was no significant difference in progression-free survival between the two groups under IMRT and VMAT radiotherapy.