| Objective:The occurrence and development of tumors in vivo is a series of dynamic and complex interactions between tumor cells and the immune system.In recent years,tumor immunity is one of the hot topics in tumor research.The purpose of this study was to investigate the predictive value of circulating lymphocyte subsets in response to radioactive iodine therapy(RAIT)in patients with papillary thyroid carcinoma(PTC),and to further explore the clinical value of its combination with conventional predictor stimulated thyroglobulin(sTg)in the evaluation of therapeutic response.Methods:A total of 44 patients with PTC who received total thyroidectomy in preparation for the first RAIT were included in this study.The absolute counts and percentages of CD3~+T,CD4~+T,CD8~+T,B,and natural killer(NK)lymphocyte subsets in peripheral blood were determined using flow cytometry before the first RAIT and 1 month after RAIT.Serological and imaging indicators were used to evaluate the response to therapy of PTC patients at 6-12 months after RAIT.According to the 2015 American Thyroid Association(ATA)guidelines,patients were split into excellent response(ER)group and non-excellent response(NER)group.The NER group includes"indeterminate response"(IDR),"biochemical incomplete response"(BIR)and"structural incomplete response"(SIR).Results:1.The number of lymph node metastasis(P=0.045)and sTg(P<0.001)level in ER group were significantly lower than those in NER group.2.The absolute counts of CD3~+T(P<0.001),CD4~+T(P<0.001),CD8~+T(P=0.023)and B(P<0.001)lymphocyte subsets in PTC patients after RAIT were significantly lower than those before RAIT.The percentages of lymphocyte subsets of CD4~+T(P<0.001),CD8~+T(P<0.001),B(P<0.001)and NK(P<0.001)before and after RAIT also had statistical significance.3.The absolute counts of CD3~+T(P=0.020),CD4~+T(P=0.007)and B(P=0.011)lymphocyte subsets before RAIT between ER and NER groups were statistically significant,but there was no statistical difference in percentages of lymphocyte subsets between ER and NER groups(all P>0.05).There were no significant differences in absolute counts and percentages of lymphocyte subsets after RAIT between ER and NER groups(all P>0.05).4.ROC curves were used to analyze the predictive value of absolute counts of peripheral blood lymphocyte subsets(CD3~+T,CD4~+T and B cells),sTg and number of lymph node metastases in patients with PTC.The AUCs were 0.717(95%CI:0.554-0.880),0.739(95%CI:0.572-0.906),0.732(95%CI:0.576-0.889),0.826(95%CI:0.680-0.972)and 0.683(95%CI:0.521-0.846),respectively.The cut-off values were1040(sensitivity=87.5%,specificity=50.0%),662.4(sensitivity=68.8%,specificity=85.7%),234(sensitivity=68.8%,specificity=75.0%),5.94(sensitivity=68.8%,specificity=96.4%)and 9.5(sensitivity=50.0%,specificity=78.6%),respectively.5.The multivariate logistic analysis revealed that sTg(OR=1.219,95%CI:1.066-1.395,P=0.004)and CD4~+T absolute count(OR=1.009,95%CI:1.002-1.016,P=0.014)were independent predictors of therapeutic response in patients with PTC.Their combined value was higher in the assessment of therapeutic response in patients with PTC,with a combined AUC of 0.931(95%CI:0.857-1.000).Conclusion:1.Some lymphocyte subsets in PTC patients transiently decreased after RAIT.2.There are differences in the distribution of lymphocyte subsets before RAIT in PTC patients with different therapeutic response.The absolute counts of lymphocyte subsets can more accurately reflect the patients’immune status than their percentages,and can be used as a hematological marker to predict the efficacy of PTC patients to RAIT.3.Absolute counts of peripheral blood lymphocyte subsets(CD3~+T,CD4~+T and B lymphocyte subsets),sTg and number of lymph node metastases have predictive value for the therapeutic response of PTC patients.4.sTg and CD4~+T are independent predictors of therapeutic response in PTC patients.CD4~+T combined with sTg can significantly improve the predictive value of therapeutic response in PTC patients. |
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