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目的:探索同步放化疗(CCRT)前及治疗后外周血淋巴细胞(pLYM)数对患者生存期影响及治疗后pLYM变化与总生存期关系。方法:筛选2008年9月-2013年1月在本院经细胞学或组织学确诊为宫颈鳞癌、腺癌或腺鳞癌,并完成同步放化疗±手术的患者424例。回顾性分析符合本研究要求患者的所有临床资料,记录治疗前、治疗完成2周后pLYM数,用Kaplan-Meier对治疗前后不同pLYM水平的患者进行生存分析,比较不同化疗周期数±手术的患者3年总生存率(OS)。结果:患者中位年龄52岁,所有患者行CCRT±手术。治疗前基线pLYM中位值1.48×10~9/L,基线pLYM<1.48×10~9/L和≥1.48×10~9/L的患者中位OS分别为40个月,56.5个月;3年OS分别为76.1%,93.4%;5年OS分别为52.3%,80.4%。CCRT完成后2周pLYM中位值1.33×10~9/L,pLYM<1.33×10~9/L和pLYM≥1.33×10~9/L患者的中位OS分别为38.0个月,60.0个月;3年OS分别为71.5%,94.2%;5年OS分别为49.3%,80.7%。结论:pLYM可以作为宫颈癌的独立预后因素,较高水平的基线pLYM和治疗后pLYM水平升高的患者预后较好。
Objective: To investigate the influence of the number of peripheral blood lymphocytes (pLYM) before and after concurrent chemoradiotherapy (CCRT) on the survival and the relationship between the changes of pLYM and the overall survival after treatment. METHODS: A total of 424 patients with cervical squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma diagnosed as cytology or histology in our hospital from September 2008 to January 2013 were included in the study. The clinical data of patients who met the requirements of this study were retrospectively analyzed. Before treatment, the number of pLYM was recorded 2 weeks after the completion of treatment. The survival of patients with different pLYM levels before and after treatment was analyzed by Kaplan-Meier. The patients with different cycles of chemotherapy were compared 3-year overall survival (OS). Results: The median age was 52 years and all patients underwent CCRT ± surgery. The median pre-treatment pLYM median was 1.48 × 10 ~ 9 / L, and the median OS of patients with baseline pLYM <1.48 × 10 ~ 9 / L and ≥1.48 × 10 ~ 9 / L were 40 months and 56.5 months respectively. The annual OS was 76.1% and 93.4% respectively. The 5-year OS was 52.3% and 80.4% respectively. The median OS of pLYM 1.33 × 10 ~ 9 / L, pLYM <1.33 × 10 ~ 9 / L and pLYM≥1.33 × 10 ~ 9 / L were 38.0 months and 60.0 months ; 3-year OS was 71.5%, 94.2%; 5-year OS were 49.3%, 80.7%. Conclusion: pLYM can be used as an independent prognostic factor for cervical cancer. Patients with higher levels of pLYM at baseline and pLYM after treatment have a better prognosis.