| Background and objective:In recent years, The incidence and prevalence of bladder cancer increased significantly with the progress of global industrialization and human longevity worldwide. It ranks eleventh of all malignant tumors and has aroused a inevitable health problems. According to the pathological types and clinical stages difference of bladder cancer, it take individualized treatment measures,including major surgery, adjuvant intravesical chemotherapy,etc.Postoperative recurrence rate is still high for patients with bladder cancer and has aroused widely concern of surgeon.In recent years, with regard to tumor immunotherapy has become a hot topic in medicine, the majority of studies have reported the occurrence of cancer mechanism is due to reduced immune system.Tumor-associated immune regulatory T cells(Treg) are critical in tumor generation, many previous studies indicate significantly higher Treg level in lung cancer, gastrointestinal cancer, liver cancer,ovarian cancer and other solid tumors as well as hematological malignancies compared with healthy controls. While the literatures refer to Treg of bladder cancer is rare. This study aims to find the relationship between Treg and bladder carcinoma accurence by detecting the outer peripheral blood CD4+CD25+CD127low/-Treg cellular level of bladder cancer patients and detect the affect of surgery combined epirubicin intravesical chemotherapy for bladder cancer in human peripheral blood CD4+CD25+CD127low/-Treg cellular level, in order to bring new ideas about patient prognosis and treatment strategies.Materials and methods : Collects 70 cases each of the following periods peripheral blood of bladder cancer patients from February 2014 to January 2015 in Second Affiliated Hospital of Nanchang University(Among those patients, there are56 male and 14 female, 60 cases of non-muscle-invasive bladder cancer and 10 cases of muscle-invasive bladder cancer. Within the 60 patient cases of non-muscleinvasive bladder cancer, there are primary cases 41& recurrence cases 19, and in the primary cases,there are high level of pathological 12 & low level 29),collect their peripheral blood of preoperative one day,surgery joint immediate intravesicalchemotherapy with epirubicin of postoprative one day,one week,one month,the only surgery of postoprative one day,and 20 cases of healthy control.Three-color immunofluorescence and flow cytometry(FCM) are applied to detect CD4+CD25+CD127low/-Treg/CD4+T cell ratio.Result:1.The ratio of CD4+CD25+CD127low/-Treg/CD4+ T lymphocyte in bladder cancer patient peripheral blood(12.36±2.74%) was significantly higher than that of healthy control group(5.34±1.31%),P<0.01;The ratio of CD4+CD25+CD127low/-Treg/CD4+ T lymphocyte in bladder cancer patient peripheral blood:male(12.53±2.24%)compare with female(11.97±1.93%),the difference is not obvious,P>0.05;Age>60 years old(12.49±2.21%) compare with ≤60 years old(12.05±1.88%),the difference is not obvious,P>0.05.2.The ratio of CD4+CD25+CD127low/-Treg/CD4+T lymphocyte of muscle invasive bladder cancer patients( 13.17±2.92%) was significantly higher than non-invasive ones( 10.66±1.86%), P<0.05; It is significantly higher ratio of CD4+CD25+CD127low/-Treg/CD4+T cell in recurrent patients’ venous blood( 11.81±2.07%) make a comparison with primary ones’( 9.30±1.81%) with non-muscle invasive bladder cancer, P<0.01; non-muscle invasive bladder cancer blood ratio: relapse(10.47+1.20%) compared with primary(8.53+0.87%) increased,P<0.01; primary pathological grading the higher(10.52±2.01%) compared with those lower grade(8.78±1.39%) increase, P <0.05.3.The CD4+CD25+CD127low/-Treg/CD4+T cell ratio of non-muscle invasive bladder cancer in postoperative days(POD) 1( 8.54±1.27%) and postoperative weeks(POW) 1(8.23±1.41%)and postoperative months(POM) 1(7.04±1.56%)is significantly lower than one day(12.30±2.31%) before surgery after the surgery combined immediate epirubicin bladder infusion chemotherapy(P<0.01);The ratio in POM1 is significantly lower than POD1 and POW1,P <0.05;The ratio in POD1 and POW1 after the surgery combined immediate epirubicin bladder infusion chemotherapy are significantly lower than POD1(9.88±1.43%)and POW1(9.53±1.52)with surgery alone group,respectively,P<0.05;The ratio in POD1 and POW1 with surgery alone group are significantly lower than preoperative one day,P<0.05;Theratio of the two group in POD1 have not significant difference when compared with POW1,P>0.05.Conclusion:1.The ratio of outer periphery of bladder cancer blood CD4+CD25+CD127low/-Treg/CD4+T cell was significantly higher than the healthy control group, suggesting that anti-tumor immune function is impaired and come into tolerance of tumors.2.The higher the ratio of CD4+CD25+CD127low/-Treg/CD4+T cells in peripheral blood with bladder cancer patients, the more chance of tumor recurrence and tend to muscle invasion; The higher of tumor grade, the worse of overall prognosis.3.Surgery combined with epirubicin chemotherapy can significantly reduce the ratio of CD4+CD25+CD127low/-Treg/CD4+ T cell of peripheral blood for non-muscle invasive bladder cancer patients, not only anti-tumor immune function can also be restored, but reduce tumor recurrence and infiltration of progress. Thus,in terms of immunity,the combination of surgery and epirubicin chemotherapy is an effective method of treatment for clinical non-muscle invasive bladder cancer. |
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