Study On The Relationship Between Peripheral Blood Immune Indexes And Treatment And Prognosis Of Patients With Epithelial Ovarian Cancer

Objective:To explore the relationship between immune indexes in peripheral blood and treatment and prognosis of patients with Epithelial Ovarian Cancer(EOC),in order to provide reference for clinical decision-making and immunotherapy choice of patients with ovarian cancer.Methods:The clinicopathological data of patients with EOC diagnosed in Yunnan Cancer Hospital from January 2016 to June 2022 were collected retrospectively.All patients in the group underwent Primary Debulking Surgery(PDS)in our hospital,and 6 courses of platinum regimen chemotherapy were completed after operation.A total of 82 patients were selected.The patients with surgical stage Ⅰ-Ⅱ were regarded as early,and those with stage Ⅲ-Ⅳ were classified as advanced.The immune indexes of early and late patients during treatment included lymphocyte subsets(CD3%,CD4%,CD8%,CD4/CD8,NK%,CIK%)and cytokines(INF-γ,TNF-α,IL-10,IL-6,IL-4,IL-2),inflammatory markers(PLR,NLR)and tumor markers(CA125,HE4).The relationship between the changes of related indexes and treatment and prognosis was analyzed.Results:1.Comparison of preoperative immune and inflammatory indexes in patients with different clinicopathological stages : The levels of NLR(P=0.027),PLR(P=0.019),CA125(P=0.002)and HE4(P=0.001)were higher in late stage than in early stage,and the difference between groups was statistically significant.There was no significant differences in the expression levels of CD3%,CD4%,CD8%,CD4/CD8 %,NK%,CIK%,INF-γ,TNF-α,IL-10,IL-6,IL-4 and IL-2 between the two groups(P >0.05).2.Effect of intraoperative blood transfusion on peripheral blood immune Indexes of postoperative patients:In patients with early stage,the expression level of IL-6 in peripheral blood of the transfusion group was higher than that of the nontransfusion group,and the difference between the two groups was statistically significant(P=0.047).There was no significant difference in the expression levels of CD4%,CD8%,CD4/CD8,NK%,CIK%,INF-γ,TNF-α,IL-10,IL-6,IL-4 and IL-2between groups(P>0.05).In the patients with advanced stage,the expression levels of CD3%(P=0.037)and CD8%(P=0.029)in the transfusion group were lower than those in the non-transfusion group,and the difference was statistically significant.There was no significant difference in the expression of CD4%,CD4/CD8,NK%,CIK%,INF-γ,TNF-α,IL-10,IL-6,IL-4 and IL-2 between the two groups(P>0.05).3.Effect of surgery on peripheral blood immune indexes of postoperative patients:There were no significant differences in the expression levels of CD3%,CD4%,CD8%,CD4/CD8 %,NK%,CIK%,INF-γ,TNF-α,IL-10,IL-6,IL-4 and IL-2in early patients before and after surgery(P > 0.05).The expression level of CD8% in advanced patients was higher after surgery than before surgery(P=0.048),and the expression level of CD4/CD8 was lower after surgery than before surgery(P=0.027).There was no significant difference in the expression of CD3%,CD4%,NK%,CIK%,INF-γ,TNF-α,IL-10,IL-6,IL-4 and IL-2 before and after surgery(P > 0.05).4.Effect of residual tumor on immune indexes in peripheral blood of postoperative patients:The expression level of CIK% in patients with satisfactory tumor reduction was higher than that in patients with dissatisfied tumor reduction,and the difference between groups was statistically significant(P=0.012).There was no significant difference in the expression of CD3%,CD4%,CD8%,CD4/CD8,NK%,INF-γ,TNF-α,IL-10,IL-6,IL-4 and IL-2 between the two groups(P > 0.05).5.Difference analysis of peripheral blood immune indexes during chemotherapy: In early stage patients,the expression level of CD3% increased gradually during chemotherapy(P=0.025),and the expression level of NK% decreased gradually(P=0.019).There was no significant differences in the expression levels of CD4%,CD8%,CD4/CD8,CIK%,INF-γ,TNF-α,IL-10,IL-6,IL-4 and IL-2 during chemotherapy(P > 0.05).In advanced patients,the expression levels of CD3%(P=0.001)and CD4%(P=0.005)increased gradually during chemotherapy,while the expression level of NK%(P=0.04)decreased gradually in the early stage of chemotherapy,and then increased in the late stage.There were no significant differences in the expression levels of CD8%,CD4/CD8,CIK%,INF-γ,TNF-α,IL-10,IL-6,IL-4and IL-2 during chemotherapy(P > 0.05).6.Effect of peripheral blood Lymphocyte Subsets level on prognosis in patients with late stage of chemotherapy:The median follow-up time for advanced patients was 30(8-70)months,and the median Disease Free Survival(DFS)was 18(3-70)months.After chemotherapy,10 cases of CD8% decreased,8 cases of recurrence(8/10,80%),26 cases of CD8% normal,8 cases of recurrence(8/26,30.77%),11 cases of increased CD8%,2 cases of recurrence(2/11,18.18%),the median DFS of the decreased CD8% group was 13 months.Normal group and higher median DFS hasn’t been attained,and CD8% decrease with poor prognosis in patients with normal group,the higher group,statistically significant difference between group(P=0.032).There was no significant difference in DFS among the three groups with different levels of CD4/CD8(P > 0.05).Conclusions:1.The inflammatory markers PLR and NLR in advanced EOC patients were higher than those in early EOC patients.2.Intraoperative blood transfusion can increase the expression level of IL-6 in early EOC patients and decrease the expression levels of CD3% and CD8% in advanced patients.Intraoperative blood transfusion may inhibit postoperative immune function and affect anti-tumor immunity response in EOC patients.3.Surgery can improve the immunosuppression of patients with advanced EOC,and the postoperative immune level of patients with unsatisfied tumor reduction is different from that of patients with satisfactory tumor reduction.4.Chemotherapy can not only enhance the anti-tumor immune response of EOC patients,but also affect the activity of some immune cells.5.The prognosis of advanced EOC patients with decreased peripheral blood CD8%after chemotherapy was worse than that of normal or elevated patients.