The Prediction Of Peripheral Blood Cells On The Efficacy Of SBRT In Lung Tumors

Objective: The incidence and mortality of lung cancer remain high.stereotactic body radiotherapy(SBRT)is a new treatment method.There are differences in the efficacy of SBRT among individuals,but there is still a lack of simple and easily available evaluation indexes in clinic.Radiotherapy can affect the immune system and immune microenvironment,and the changes of peripheral blood cells can reflect the radiosensitivity of the body to a certain extent,which is closely related to the immune status of the body.In this study,we evaluated the efficacy and adverse reactions of SBRT in patients with lung cancer,made clear the prognostic value of circulating lymphocyte counts(CLCs)in lung cancer SBRT patients and investigated the changes of TBNK lymphocyte subsets and cytokines in peripheral blood before and after SBRT treatment.Methods: We retrospectively analyzed 191 lung cancer SBRT patients in XX Hospital from September 2014 to December 2018.The medical record system of Taizhou Hospital was used to collect relevant clinical data.Chest CT scan was examined at 1 month,3 months and 6 months after the SBRT.The RECIST 1.1 standard was used to evaluate the short-term efficacy in the first,third,and sixth months after SBRT.Follow-up and record PFS and OS.The lymphocyte subsets were detected by flow cytometry: absolute values of CD3,CD4,CD8.The concentrations of IL-2,IL-4,IL-6,IL-10,IFN-γ and TNF-α were detected by Elisa.Survival curves and univariate,multivariate logistic/COX-regression analyses were used to expound the prognostic factors for local control(LC),PFS,and OS of lung cancer SBRT patients.Results:1.The disease control rates of 191 patients in one-,three-and six-months were 97.4%,90.6% and 75.9%,respectively.The median OS was 32 months in all patients.2.Univariate and multivariate analysis results showed that post-SBRT CLCs were independent factors for the short-term efficacy 3 and 6 months after lung cancer SBRT(3month LC: OR: 0.25,95%CI=0.067-0.921,P=0.04;6month LC: OR: 0.35,95%CI=0.152-0.794,P=0.01).3.The patients with high post-SBRT CLCs in the nonA blood group had the longest PFS and OS after lung cancer SBRT,the median of PFS and OS was 11 and 42 months.4.Flow cytometry showed that the absolute values of CD4 decreased,while the absolute values of CD8 increased after SBRT.5.Elisa showed that after SBRT,the concentrations of IL-4、IL-10 increased.Conclusions: SBRT is a safe and effective treatment for clinically inoperable lung tumor patients.CLCs after SBRT is related to LC,PFS and OS in lung tumors.SBRT can affect the distribution of peripheral lymphocyte subsets and cytokine concentration,and activate the anti-tumor immune function of the body.The potential mechanism of these relationships is worthy of further verification and investigation.