Early Changes Of Peripheral Blood Lymphocyte Subsets And Clinical Significance In Patients With Lung Adenocarcinoma After Single-port Thoracoscopic Lobectomy

BackgroundLung cancer is the most common malignant tumor,among which the incidence of lung adenocarcinoma is increasing year by year,accounting for 50%of lung cancer.Minimally invasive surgery represented by single-port thoracoscopic lobectomy has become the preferred treatment for early lung cancer.Tumor-related factors and thoracoscopic surgery may affect the immune function of lung cancer patients.With the development of tumor immunology and the concept of rapid recovery in surgery,the changes of immune function of patients with lung cancer after surgery have attracted more and more attention from clinicians.However,immune function changes in early stage patients with lung adenocarcinoma after single-port thoracoscopic lobectomy have not been reported.ObjectiveTo observe the changes of T,B and NK lymphocyte subsets in the early peripheral blood of patients with lung adenocarcinoma after single-port thoracoscopic lobectomy,and to explore the relationship between them and clinic pathological factors of patients and the possible clinical significance.MethodsAccordingtoinclusionandexclusioncriteria,alllung adenocarcinomapatientstreatedwithsingle-portthoracoscopic pneumonectomy in our hospital from March 2018 to August 2018 were selected,and peripheral venous blood was collected on the day of admission(D0),the first day after surgery(D1)and the fifth day after surgery(D5).The blood cell counter and flow cytometry were used to detect the counts of T(CD4~+、CD8~+),B(CD19~+)and NK(CD56~+)cells.At the same time,the variations of cell counts of T,B and NK before and after-operation(ΔD0-1,ΔD0-5 andΔD1-5)were respectively calculated.The correlations between the characteristic change of cell counts in the early postoperative period with clinicopathological parameters of patients were analyzed.ResultsAccording to the inclusion and exclusion criteria,a total of 66patients were included.At D0,the counts of CD8~+T lymphocyte cells of non-smoking patients was higher than that of smoking patients(t=2.162,P<0.05),while the counts of CD19~+B lymphocyte cells was lower(t=-1.137,P<0.05).The counts of CD8~+T lymphocyte cells was higher in stage T1patients than in stage T2-4 patients(t=1.684,P<0.05).At D1,there was no significant difference in the counts of lymphocyte subgroups among patients in different subgroups.At D5,the counts of CD8~+T lymphocyte cells of non-smoking patients was higher than that of smoking patients(t=1.974,P<0.05).The counts of CD19~+B lymphocyte cells in stage T1patients was higher than that in stage T2-4 patients(t=1.431,P<0.05).The counts of CD19~+B lymphocyte cells of stage I patients was higher than that of stage II-III patients(t=2.134,P<0.05).Compared with D0,the counts of CD4~+T,CD8~+T,CD19~+B and CD56~+NK lymphocyte cells in peripheral blood of patients in the early postoperative period were significantly decreased at D1 and D5(P<0.01).Compared with D1,the counts of CD4~+T and CD8~+T lymphocyte cells were significantly increased at D5(t=5.362,P<0.01;t=5.202,P<0.05),the counts of CD19~+B and CD56~+NK lymphocyte cells showed a decreasing trend,but the difference was not statistically significant(P>0.05).The variation in CD4~+T cell count of male patients(ΔD1-5)was higher than that of female patients(r=-0.181,t=1.707,P<0.05).The variation in CD8~+T cell counts(ΔD0-1 andΔD0-5)was significantly decreased with an increase in tumor size(r=-0.366,t=-0.377,P<0.01;r=-0.252,t=0.451,P<0.05).The variation in CD19~+B cell count(ΔD0-5 andΔD1-5)in stage II~III was markedly higher than that in stage I(r=0.301,t=2.075,P<0.05;r=0.262,t=2.140,P<0.05).The variation of cell counts of CD56~+NK(ΔD0-5)was significantly associated with age and smoking status.The variation of cell in Older patients(≥60 years)was lower than that in the younger(<60 years)and the variation of cell in smokers was lower than in non-smokers(r=-0.086,t=1.557,P<0.05;r=0.043,t=-0.592,P<0.05).The variation of cell counts of CD56~+NK(ΔD1-5)was obviously decreased with an increase in tumor size(r=-0.286,t=1.158,P<0.05).ConclusionAfter single-port thoracoscopic lobectomy for lung adenocarcinoma,the counts of peripheral blood lymphocyte subsets decreased in the early stage,and the changes of the counts of lymphocyte subsets were correlated with different clinicopathological parameters such as age,gender,smoking status,tumor pathological type and T stage.It is of great clinical significance to analyze the changes of perioperative immune function in patients with different clinical parameters to provide individual immunosupport therapy in perioperative period.