Immune reactivity does not predict chemotherapy response, organ preservation, or survival in advanced laryngeal cancer
Immune reactivity does not predict chemotherapy response, organ preservation, or survival in advanced laryngeal cancer
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DOI：
10.1097/00005537-200208000-00006
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发表时间：
2002-08-01
期刊：
影响因子：
2.6
通讯作者：
Hogikyan, ND
中科院分区：
文献类型：
--
作者：
Wolf, GT;Bradford, CR;Hogikyan, ND
目的：确定作为器官保护治疗方法一部分的诱导化疗是否与晚期喉癌患者治疗前的淋巴细胞亚群相关。研究设计：对晚期喉癌患者进行前瞻性临床试验，以确定是否可以使用一个周期的新辅助化疗来选择保留器官的患者，以确定是否可以改善晚期保喉手术的频率和总的生存时间。治疗前外周血淋巴细胞CD3、CD4、CD8、NK和B细胞亚群与肿瘤诱导化疗反应、保喉和生存期相关，以确定免疫参数是否可用于患者的选择。方法：研究环境为三级转诊学术卫生中心。研究对象为53名III期(42%)或IV期(57%)喉癌患者。大多数患者有声门上癌(73%)和临床结节阳性(51%)。68%的患者在一个周期的诱导化疗后肿瘤缓解率超过50%，然后同时接受放化疗和两个周期的辅助化疗。对39例患者进行了淋巴细胞亚群检测。平均随访23.3个月(5~61个月)。结果：18例(34%)患者接受了喉切除术。仅4例晚期(治疗后13~35mo)行手术切除。14例在初次化疗后计划手术。在检测到的淋巴细胞亚群中，CD8水平在IV期患者中显著降低，在成功保存器官的患者中趋于降低。然而，在对化疗有反应和无反应的患者中，发现淋巴细胞亚群没有显著差异。总存活率为88%。结论：1个周期的新辅助化疗是选择器官保存患者的有效方法。明确的同步辅助化疗方案与出人意料的高2年存活率有关。淋巴细胞亚群不是有反应的患者或生存期的显著预测因子。对其他有助于选择器官保存患者的生物标记的进一步研究是必要的。
Objective: To determine whether pretreatment lymphocyte subpopulations correlate with tumor response to induction chemotherapy as part of an organ preservation treatment approach in patients with advanced laryngeal cancer. Study Design: A prospective clinical trial in patients with advanced laryngeal cancer was undertaken to determine whether the frequency of late salvage laryngectomy and overall survival could be improved using one cycle of neoadjuvant chemotherapy to select patients for organ preservation. Pretreatment peripheral blood lymphocyte subpopulations for CD3, CD4, CD8, NK, and B cells were correlated with tumor response to induction chemotherapy, larynx preservation, and survival, to determine whether immune parameters could be useful in patient selection. Methods: The study setting was a tertiary referral academic health center. Studied were 53 patients with stage III (42%) or IV (57%) larynx cancer. Most patients had supraglottic cancers (73%) and positive clinical nodes (51%). Sixty-eight percent had greater than 50% tumor response after one cycle of induction chemotherapy and then received concurrent chemoradiation and two cycles of adjuvant chemotherapy. Lymphocyte subpopulations were measured in 39 patients. Mean follow-up was 23.3 months (range, 5-61 mo). Results: A total of 18 (34%) patients underwent laryngectomy. Only 4 cases were late salvage resections (13-35 mo after treatment). Fourteen cases were planned surgery after initial chemotherapy. Of the lymphocyte subpopulations measured, CD8 levels were significantly lower in stage IV patients and tended to be lower in patients with successful organ preservation. However, no significant differences in lymphocyte subpopulations were found among responders and nonresponders to chemotherapy. Overall survival was 88%. Conclusions: One cycle of neoadjuvant chemotherapy was effective in selecting patients for organ preservation. The regimen of definitive concurrent and adjuvant chemotherapy was associated with an unexpectedly high 2-year survival rate. Lymphocyte subsets were not significant predictors of responding patients or survival. Further study of other biological markers useful in selecting patients for organ preservation are needed.