分化型甲状腺癌患者细胞因子与淋巴细胞亚群的特征及其与预后的关系
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1.江苏省苏州市第九人民医院 甲乳外科,江苏 苏州 215200;2.安徽省马鞍山市十七冶医院 甲乳外科,安徽 马鞍山243000

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于枫,江苏省苏州市第九人民医院副主任医师,主要从事甲状腺、乳腺疾病临床特点及手术治疗方面的研究。

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Characteristics of cytokines and lymphocyte subsets in differentiated thyroid carcinoma patients and their relationship with prognosis
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1.Department of Thyroid and Breast Surgery, the Ninth People's Hospital of Suzhou City, Suzhou, Jiangsu215200, China;2.Department of Thyroid and Breast Surgery, the 17th Metallurgical Hospital, Ma'anshan, Anhui243000, China

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    摘要:

    背景与目的 分化型甲状腺癌(DTC)包括甲状腺乳头状癌(PTC)和甲状腺滤泡状癌(FTC),是常见的甲状腺癌类型。尽管大多数DTC患者经规范治疗后预后较好,但部分DTC患者仍会发生包膜侵袭和淋巴转移,造成预后不良。研究证实炎症及免疫因素在肿瘤发展中的重要作用,但在DTC中仍缺乏系统研究,因此,本研究分析DTC患者细胞因子与淋巴细胞亚群的特征及其与预后的关系。方法 选取2018年5月—2021年5月在江苏省苏州市第九人民医院及安徽省马鞍山市十七冶医院甲乳外科就诊的DTC患者为研究对象,其中PTC与FTC患者各43例,并选取同一时期诊断为良性甲状腺结节(BTN)的患者43例为对照组。比较三组患者治疗前细胞因子(TNF-α、IL-1β、IL-2、IL-6、IL-8、IL-10、IL-27)水平与淋巴细胞亚群(T细胞、Ts细胞、Th细胞、B细胞、NK细胞)计数;分析DTC患者临床病理特征与细胞因子及淋巴细胞亚群的关系;对比DTC患者术后细胞因子及淋巴细胞亚群的变化;分析上述细胞因子及淋巴细胞亚群计数对DTC患者治疗效果的预测价值。结果 三组间比较结果显示,TNF-α、IL-1β、IL-6水平在PTC组与FTC组均高于BTN组(均P<0.05),而PTC组与FTC组间无明显差异(P>0.05);三组间IL-2、IL-8水平无明显差异(P>0.05);IL-10水平在PTC组与FTC组均低于BTN组,且FTC组低于PTC组(均P<0.05);IL-27水平在PTC组与FTC组均高于BTN组,且FTC组低于PTC组(均P<0.05)。三组间T细胞、B细胞、NK细胞计数均无明显差异(均P>0.05);PTC组与FTC组的Ts细胞计数高于BTN组,且FTC组患者的Ts细胞计数高于PTC组(均P<0.05);PTC组与FTC组的Th细胞计数均低于BTN组(均P<0.05),PTC组与FTC组间Th细胞计数无明显差异(P>0.05)。分析上述有差异的细胞因子及淋巴细胞亚群与DTC患者临床病理特征的关系,结果显示,年龄较大的患者IL-6水平较高,进展期患者Ts细胞计数较高,有BRAF突变的患者IL-10水平较低(均P<0.05)。对于PTC患者,术后TNF-α、IL-6、IL-27水平及Ts细胞计数水平对治疗效果具有预测价值(均P<0.05),曲线下面积(AUC)分别为0.754、0.784、0.781、0.754;对于FTC患者,术后IL-8、IL-27及Ts细胞计数水平对治疗效果具有预测价值(均P<0.05),AUC分别为0.707、0.788、0.715;对于总体DTC患者,术后TNF-α、IL-27、Ts细胞计数水平对治疗效果有预测价值(均P<0.05),AUC分别为0.742、0.783、0.854。结论 细胞因子水平及淋巴细胞亚群的计数在DTC患者中具有一定的特点,并可能与患者临床病理特征相关联,术后相关细胞因子水平与淋巴细胞亚群计数对DTC患者的治疗效果有潜在的预测价值。

    Abstract:

    Background and Aims Differentiated thyroid carcinoma (DTC), comprising papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), is the most common type of thyroid cancer. While the majority of DTC patients have a favorable prognosis with standardized treatment, some experience capsular invasion and lymphatic metastasis, leading to poor outcomes. Studies have demonstrated the significant roles of inflammatory and immune factors in tumor progression, but systematic research on their involvement in DTC is lacking. This study aims to analyze the characteristics of cytokines and lymphocyte subsets in DTC patients and their relationships with prognosis.Methods DTC patients treated at the Departments of Thyroid and Breast Surgery of Suzhou Ninth People's Hospital and Ma'anshan 17th Metallurgical Hospital between May 2018 and May 2021 were included, comprising 43 PTC patients and 43 FTC patients. An additional 43 patients diagnosed with benign thyroid nodules (BTN) during the same period served as the control group. The levels of cytokines (TNF-α, IL-1β, IL-2, IL-6, IL-8, IL-10, IL-27) and counts of lymphocyte subsets (T lymphocytes, Ts cells, Th cells, B lymphocytes, NK cells) were compared among the three groups before treatment. The relations of cytokines and lymphocyte subsets with clinicopathologic characteristics in DTC patients were analyzed. Changes in cytokines and lymphocyte subsets in DTC patients after surgery were evaluated, and the predictive value of these factors for treatment outcomes was assessed.Results Comparisons among the groups showed that TNF-α, IL-1β, and IL-6 levels were higher in the PTC and FTC groups than that in the BTN group (all P<0.05), with no significant difference between the PTC and FTC groups (P>0.05); IL-2 and IL-8 levels had no significant differences among the three groups (P>0.05); IL-10 levels were lower in the PTC and FTC groups than that in the BTN group, and lower in the FTC group than that in the PTC group (all P<0.05); IL-27 levels were higher in the PTC and FTC groups than that in the BTN group, with higher levels in the PTC group than that in the FTC group (all P<0.05). No significant differences were observed among the three groups in the counts of T lymphocytes, B lymphocytes, or NK cells (all P>0.05); Ts cell counts were higher in the PTC and FTC groups than that in the BTN group and higher in the FTC group than in that the PTC group (all P<0.05); Th cell counts were lower in the PTC and FTC groups than that in the BTN group (both P<0.05), with no significant difference between the PTC and FTC groups (P>0.05). Analysis of relationships between these differential cytokines and lymphocyte subsets with clinicopathologic features of DTC patients revealed that older patients had higher IL-6 levels, patients in advanced stages had higher Ts cell counts, and those with BRAF mutations had lower IL-10 levels (all P<0.05). Postoperative levels of TNF-α, IL-6, IL-27, and Ts cell count were predictive of treatment outcomes in PTC patients (all P<0.05), with AUC values of 0.754, 0.784, 0.781, and 0.754, respectively. For FTC patients, postoperative IL-8, IL-27, and Ts cell count predicted treatment outcomes (all P<0.05), with AUC values of 0.707, 0.788, and 0.715, respectively. For all DTC patients, postoperative TNF-α, IL-27, and Ts cell count were predictive of treatment outcomes (all P<0.05), with AUC values of 0.742, 0.783, and 0.854, respectively.Conclusion Cytokine levels and lymphocyte subset counts exhibit specific characteristics in DTC patients and may be associated with clinicopathological features. Postoperative levels of certain cytokines and lymphocyte subsets have potential predictive value for treatment outcomes in DTC patients.

    图1 DTC患者术后细胞因子及淋巴亚群对治疗效果的评估价值分析 A:PTC患者术后血清TNF-α、IL-1β、IL-2、IL-6、IL-8、IL-10预测治疗效果ROC曲线;B:PTC患者术后血清IL-27以及外周血T细胞、B细胞、NK细胞、Th细胞、Ts细胞计数预测治疗效果ROC曲线;C:FTC患者术后血清TNF-α、IL-1β、IL-2、IL-6、IL-8、IL-10预测治疗效果ROC曲线;D:FTC患者术后血清IL-27以及外周血T细胞、B细胞、NK细胞、Th细胞、Ts细胞计数预测治疗效果ROC曲线;E:全组DTC患者术后血清TNF-α、IL-1β、IL-2、IL-6、IL-8、IL-10预测治疗效果ROC曲线;F:全组DTC患者术后血清IL-27以及外周血T细胞、B细胞、NK细胞、Th细胞、Ts细胞计数预测治疗效果ROC曲线Fig.1 Analysis of the predictive value of postoperative cytokines and lymphocyte subsets for treatment outcomes in DTC patients A: ROC curves for serum TNF-α, IL-1β, IL-2, IL-6, IL-8, and IL-10 in predicting treatment outcomes in PTC patients after surgery; B: ROC curves for serum IL-27 and peripheral blood T cells, B cells, NK cells, Th cells, and Ts cells in predicting treatment outcomes in PTC patients after surgery; C: ROC curves for serum TNF-α, IL-1β, IL-2, IL-6, IL-8, and IL-10 in predicting treatment outcomes in FTC patients after surgery; D: ROC curves for serum IL-27 and peripheral blood T cells, B cells, NK cells, Th cells, and Ts cells in predicting treatment outcomes in FTC patients after surgery; E: ROC curves for serum TNF-α, IL-1β, IL-2, IL-6, IL-8, and IL-10 in predicting treatment outcomes in the entire group of DTC patients after surgery; F: ROC curves for serum IL-27 and peripheral blood T cells, B cells, NK cells, Th cells, and Ts cells in predicting treatment outcomes in the entire group of DTC patients after surgery
    图1 DTC患者术后细胞因子及淋巴亚群对治疗效果的评估价值分析 A:PTC患者术后血清TNF-α、IL-1β、IL-2、IL-6、IL-8、IL-10预测治疗效果ROC曲线;B:PTC患者术后血清IL-27以及外周血T细胞、B细胞、NK细胞、Th细胞、Ts细胞计数预测治疗效果ROC曲线;C:FTC患者术后血清TNF-α、IL-1β、IL-2、IL-6、IL-8、IL-10预测治疗效果ROC曲线;D:FTC患者术后血清IL-27以及外周血T细胞、B细胞、NK细胞、Th细胞、Ts细胞计数预测治疗效果ROC曲线;E:全组DTC患者术后血清TNF-α、IL-1β、IL-2、IL-6、IL-8、IL-10预测治疗效果ROC曲线;F:全组DTC患者术后血清IL-27以及外周血T细胞、B细胞、NK细胞、Th细胞、Ts细胞计数预测治疗效果ROC曲线Fig.1 Analysis of the predictive value of postoperative cytokines and lymphocyte subsets for treatment outcomes in DTC patients A: ROC curves for serum TNF-α, IL-1β, IL-2, IL-6, IL-8, and IL-10 in predicting treatment outcomes in PTC patients after surgery; B: ROC curves for serum IL-27 and peripheral blood T cells, B cells, NK cells, Th cells, and Ts cells in predicting treatment outcomes in PTC patients after surgery; C: ROC curves for serum TNF-α, IL-1β, IL-2, IL-6, IL-8, and IL-10 in predicting treatment outcomes in FTC patients after surgery; D: ROC curves for serum IL-27 and peripheral blood T cells, B cells, NK cells, Th cells, and Ts cells in predicting treatment outcomes in FTC patients after surgery; E: ROC curves for serum TNF-α, IL-1β, IL-2, IL-6, IL-8, and IL-10 in predicting treatment outcomes in the entire group of DTC patients after surgery; F: ROC curves for serum IL-27 and peripheral blood T cells, B cells, NK cells, Th cells, and Ts cells in predicting treatment outcomes in the entire group of DTC patients after surgery
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于枫,陈良,王沛.分化型甲状腺癌患者细胞因子与淋巴细胞亚群的特征及其与预后的关系[J].中国普通外科杂志,2024,33(11):1775-1785.
DOI:10.7659/j. issn.1005-6947.2024.11.004

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  • 收稿日期:2024-04-03
  • 最后修改日期:2024-11-15
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  • 在线发布日期: 2024-12-18