Nested Case-control Study On Risk Factors For Skin Immune Response In Nasopharyngeal Carcinoma During Radiotherapy

Objective:Intensity-modulated radiotherapy is currently the main treatment of nasophar-yngeal carcinoma.The principle is to inhibit the growth of tumors through DNA damage,and at the same time stimulate the changes of immune function.However,there is no unified conclusion on the specific mechanism of radiotherapy leading to immune function changes.We observed that the skin immune response induced by radiotherapy has affected the treatment and life of patients with nasopharyngeal carcinoma.This article intends to use a nested case-control study designed to explore the risk factors for skin immune response in nasopharyngeal carcinoma during radiotherapy.Methods:The patients with newly diagnosed nasopharyngeal carcinoma from June 2018 to February 2019 in the Department of Oncology,the Second Affiliated Hospital of Nanchang University were followed up.Using the sputum case-control study,patients who met both the inclusion criteria and the exclusion criteria and who had a rash before the end of the first radiotherapy after the first radiotherapy were included in the observation group,according to the disease area(same province),same sex,The age(±3 years old)was matched in a ratio of 1:3 for the ratio,and the patient who did not have a rash before the end of the last radiotherapy after the first radiotherapy was included in the control group.Peripheral blood lymphocyte subsets(TBNK)detection technique were used in patients with rash and no rash to record the immune function of patients with rash and control group at the time of initial diagnosis,pre-radiation and radiotherapy(CD3~+?CD3~++CD4~+?CD3~++CD8~+?CD16~++CD56~+?CD19~+?TH/Ts)changes,and the general data of the two groups were recorded,including age,gender,stage,pathological type,induction chemotherapy,whether to install PICC tube,PS score,Body surface area,location of rash,rash classification,etc.The basic data and related immune indicators of the two groups were analyzed by single factor analysis.According to the results of single factor analysis,statistically significant indicators were included in multivariate regression analysis to explore the risk factors for skin immune response in nasopharyngeal carcinoma during radiotherapy.Results:Fifteen patients were included in the rash group and 45 patients were included in the rash.Through the univariate analysis of the basic data of the two groups of patients and the three different periods of immunological indicators at the time of initial diagnosis,pre-radiation and radiotherapy,the body surface area,CD3~++CD8~+(P=0.007),CD19~+at the time of initial diagnosis were found.(P=0.033),TH/S(P=0.004),and CD3~++CD4~+(P<0.001),CD3~++CD8~+(P=0.001),CD16~++CD56~+(P=0.019),CD19~+(P=0.002)during radiotherapy TH/Ts(P=0.001)was statistically significant(P<0.05).Statistically significant indicators were included in the multivariate regress-ion analysis.The study found that TH/Ts(P=0.013)in the initial diagnosis and CD3~++CD4~+(P=0.045)in the radiotherapy were statistically significant.The patients in the observation group were statistically described.The patients with rash were mostly male(73.3%),with an average age of 49.6 years.The most pathological type was non-keratinized undifferentiated(53.3%),mainly 2-3.Most patients with rash(66.7%)had rashes mainly in the upper body of the bilateral arms(53.3%),chest and back(13.3%),head and neck(13.3%),and some patients with rash appeared in the PICC tube.Around(26.6%),the average duration of the rash was 15.33 days.Conclusion:1.The appearance of skin immune response in nasopharyngeal carcinoma may be related to the decrease of T cell-mediated cellular immune response,and CD4~+and CD8~+may play a crucial role.2.The skin immune response in radiotherapy for nasopharyngeal carcinoma may be related to the immune function during the initial diagnosis and radiotherapy.3.The high TH/S value at the time of initial diagnosis and the low CD3~++CD4~+value in radiotherapy are independent risk factors for skin immune response during radiotherapy of nasopharyngeal carcinoma.