| Background and Objective:With the continuous improvement of the quality of human life and the increasing pace of life,the proportion of pancreatic adenocarcinoma in the population is also increasing.The development of Pancreaticoduodenectomy for pancreatic adenocarcinoma is also maturing.However,the 5-year survival rate of patients after surgery has not made great progress,and the benefits of surgery for patients are not yet known,which has caused great trouble to Surgeons.Therefore,it is very important to evaluate the prognosis of patients before surgery.Immune system affects the occurrence and development of pancreatic adenocarcinoma.CD8~+T lymphocytes,CD4~+T lymphocytes,natural killer T cells and natural killer cells are indispensable in anti-tumor immunity.Therefore,this study collected some information about patients with pancreatic adenocarcinoma who had been surgical operated in the hosptial.The purpose was to explore the effects of CD4~+T lymphocytes,CD8~+T lymphocytes,NK cells and NKT cells in the peripheral blood on postoperative survival of patients with pancreatic adenocarcinoma.Methods:The clinical data of pancreatic adenocarcinoma patients who got surgical treatment in the hospital from March 2014 to May 2018 were collected for retrospective analysis,and 67 patients with pancreatic adenocarcinoma were selected according to the inclusion and exclusion criteria.The cutoff values of CD4~+T lymphocytes,CD8~+T lymphocytes,NK cells and NKT cells were obtained from the ROC curve,and the patients were divided into high and low groups according to the cutoff value.The difference between the two groups was analyzed by statistical methods.The qualitative data was analyzed by chi-square test,Fisher's exact test,Spearman rank correlation analysis.The measurement data in multiple groups were compared with randomized analysis of variance and Kruskal-Wallis rank sum test,and p<0.05 indicated statistical significance.The Kaplan-Meier method was used to draw the survival curves of CD4~+T lymphocytes,CD8~+T lymphocytes,NK cells and NKT cells.The survival data were analyzed by Kaplan-Meier method for single factor analysis,and the statistical significance of single factor(p<0.05)was included in Cox regression for multivariate analysis,and the prognostic factors with statistical significance were calculated by p<0.05.Results:1.According to the ROC curve,the cutoff values of CD4~+T lymphocytes,CD8~+T lymphocytes,NK cells and NKT cells in pancreatic adenocarcinoma patients were 544/?l,277/?l,161/?l and 45/?l.The patients were divided into high-value group and low-value group according to the cutoff value.Gender,age,single or multiple tumors,TMN stage and number of lymph nodes metastasis of high and low group were not statistically significant,which were divided by the cutoff values of CD4~+T lymphocytes,CD8~+T lymphocytes,NK cells and NKT cells in pancreatic adenocarcinoma patients(p>0.05).The difference in survival between the high-value group and the low-value group of CD8~+T lymphocytes and NK cells in patients with pancreatic adenocarcinoma was statistically significant(p<0.05).Patients in the high-value group had longer survival.There was no significant difference in survival between the high-value group and low-value group of CD4~+T lymphocytes and NKT cells(p>0.05).2.Pancreaticoduodenectomy can increase the level of CD8~+T lymphocytes and NK cells in patients,and the difference between Preoperative and Postoperative was statistically significant(p<0.05).3.Univariate analysis showed that gender,age,single or multiple tumors,TMN stage,number of lymph node metastasis,ALB,WBC,neutrophils,NKT cell and CD4~+T lymphocytes were not related to patient's prognosis(p>0.05).CA19-9,total bilirubin,CD8~+T lymphocytes and NK cells were correlated with the prognosis of pancreatic adenocarcinoma patients(p<0.05).CA19-9,total bilirubin,CD8~+T lymphocytes and NK cells were included in the Cox regression model for multivariate analysis.The results showed that CD8~+T lymphocytes and NK cells were independent factors affecting the prognosis of pancreatic adenocarcinoma patients(p<0.05);CA19-9 and total bilirubin are not the independent risk factors for prognosis of patients with pancreatic adenocarcinoma(p>0.05).Conclusion:The level of CD8~+T lymphocytes and NK cells before surgery were independent risk factors for prognosis of pancreatic adenocarcinoma patients,and their cutoff values were 277/?l and 161/?l.The high-level group had longer survival(p<0.05).Pancreaticoduodenectomy can increase the level of CD8~+T lymphocytes and NK cells in patients(p<0.05). |
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