Distribution Of Immune Cells In Hypopharyngeal Squamous Cell Carcinoma And Its Effect On The Prognosis Of Non-operative Patients

Objective:The clinical data of 650 patients with hypopharyngeal squamous cell carci noma were studied retrospectively to explore the distribution characteristics of i mmune cells in patients with hypopharyngeal squamous cell carcinoma before t reatment and its effect on survival and prognosis.Methods:A total of 650 patients with hypopharyngeal squamous cell carcinoma diag nosed and treated in the third affiliated Hospital of Kunming Medical Universit y from November 2009 to October 2019 were selected to collect their sex,age,height,weight,smoking history,drinking history,clinical stage and treatment.Immune indexes before and after treatment(including T lymphocytes(CD3+ce lls,CD4+cells,CD8+ cells),NK cells and CIK cells),CT data(including tum or location,tumor size,lymph node metastasis,distant metastasis),clinical path ological examination and other clinical data.At the same time,650 healthy vol unteers were included as the control group.SPSS21.0 was used to compare the immune cells between the two groups.According to the distribution characteri stics of immune cells,the immune cells of patients with hypopharyngeal squam ous cell carcinoma before treatment were classified,and the relevant factors aff ecting the distribution of immune cells were analyzed.According to the differe nt treatment methods,650 patients were divided into two groups:simple chem otherapy group and radiotherapy and chemotherapy group.The survival conditio ns of all patients were followed up.The relationship between related factors an d total survival time was analyzed by Kaplan-Meier method and Log-rank test,and the survival curve was drawn.Cox regression model was used for multiv ariate analysis.P<0.05 was considered to be statistically significant.Results:1.Clinical data:650 patients with hypopharyngeal squamous cell carcinom a,including 624 males(96%)and 26 females(4%),aged 40 to 87 years old,with a median age of 58 years old.People who used to smoke and drink alco hol accounted for 76.2%and 60.8%of the total,respectively;those with thin body type,normal weight,overweight and obesity accounted for 21.5%,65.8%and 12.6%of the total,respectively;and 85.5%and 16.3%of the total had 1 ymph nodes and distant metastases,respectively.According to the location of t he tumor:piriform fossa in 494 cases(76%),posterior pharyngeal wall in 104 cases(16%),retrocricoid area in 52 cases(8%);according to the tumor clinic al stage:26 cases of stage Ⅰ(4%),Ⅱ 26 cases(4%),Ⅲ stage 39 cases(6%),I V stage 559 cases(86%).2.Distribution characteristics of immune cells before and after treatment:The distribution characteristics of peripheral blood immune cells in 650 patients with hypopharyngeal squamous cell carcinoma before treatment can be divided into five categories:221 cases(34%)in class I,143 cases(22%)in class Ⅱ,169 cases(26%)in class Ⅲ,65 cases(10%)in class Ⅳ,52 cases(8%)in cla ss V.The distribution ratio of each type is affected by age,alcohol consumptio n,BMI,tumor location,tumor size,lymph node metastasis,distant metastasis,and clinical stage(P<0.05).Compared with those before chemotherapy,CD4+T cells,CD8+T cells,NK cells and CIK cells in patients with hypopharyngeal squamous cell carcinoma increased significantly after chemotherapy(P<0.05).Compared with those before chemoradiotherapy,the ratio of CD3+T cells,CD 4+T cells and CD4+/CD8+decreased significantly,while CD8+T cells and CI K cells increased significantly in patients with hypopharyngeal squamous cell c arcinoma after chemoradiotherapy(P<0.05).3.Subsistence analysis:The median survival time of 650 patients with hy popharyngeal squamous cell carcinoma was 21 months(95%CI:19.084～22.916).The median survival time of patients with chemotherapy alone and chemora diotherapy was 15 months(95%CI:13.6～16.4)and 22 months(95%CI:20.5～23.5),respectively.The characteristic distribution of immune cells is that the medi an survival time of patients with type Ⅰ-Ⅴ respectively is 16 months(95%CI:14.1～17.9),11 months(95%CI:9.1～12.9),32 months(95%CI:29.6～34.4)),29 months(95%CI:23.4～34.6)and 23 months(95%CI:16.0～30.0).Univari ate analysis showed that age(P=0.002),lymph node metastasis(P=0.000),distant metastasis(P=0.002),clinical stage(P=0.000),treatment method(P=0.000)and classification of immune cells before treatment(P=0.000)has a n impact on the survival prognosis of patients with hypopharyngeal squamous cell carcinoma.Cox regression multivariate analysis showed that age(P=0.013,relative risk=1.335,95%CI:1.063～1.677),distant metastasis(P=0.000,rela tive risk=0.632,95%CI:0.488～0.818)3.Clinical stage(P=0.000,relative ri sk=1.957,95%CI:1.424～2.688),treatment method(P=0.003,relative risk=0.751,95%CI:0.620～0.908)and Classification of immune cells before tre atment(Class Ⅱ vs Class Ⅰ:P=0.181,relative risk=1.198,95%CI:0.919～1.562;Class Ⅲ vs Class I:P=0.000,relative risk=0.248,95%CI:is 0.192～0.321;Class Ⅳ vs.Class Ⅰ:P=0.000,relative risk=0.407,95%CI:is 0.292～0.567;Class Ⅴ vs.Class Ⅰ:P=0.004,relative risk=0.576,95%CI:0.394～0.843)isan independent risk factor for the survival prognosis of hypophar yngeal squamous cell carcinoma.Conclusions:1.The distribution characteristics of immune cells in patients with hypophar yngeal squamous cell carcinoma before treatment can be divided into five cate gories,which are affected by age,drinking,BMI,tumor location,tumor size,1 ymph node metastasis,distant metastasis and clinical stage.Among them,the p atients with type Ⅲ immune cells(tumor reactive type)had the best prognosis,and those with type Ⅳ(immune consumption type)and type ⅴ(hyperimmuni ty type)had the middle prognosis.the prognosis of patients with immunocyte distribution of type Ⅰ(immune tolerance type)and type Ⅱ(low immunity type)was the worst.The immune cells of patients with hypopharyngeal squamous c ell carcinoma should be classified before treatment,and the appropriate immun omodulatory regimen should be selected on the basis of surgery,radiotherapy o r chemotherapy.2.For non-operative patients with hypopharyngeal squamous cell carcinom a,the clinical effect of chemoradiotherapy is significantly better than that of si ngle chemotherapy,and chemoradiotherapy is easy to damage the immune func tion of the body.3.Age,distant metastasis,clinical stage,mode of treatment and distributio n of immune cells before treatment are related to the survival and prognosis of patients with hypopharyngeal squamous cell carcinoma and can be used as in dicators for evaluating the prognosis of patients with hypopharyngeal squamous cell carcinoma.