非小细胞肺癌相关胸腔积液的免疫特征及其预后意义
Immune signatures in NSCLC associated pleural effusions and implications for prognosis.
作者
作者单位
- Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), München, Germany; Asklepios Lung Clinic, Gauting, Germany; Institute of Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
- Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), München, Germany; Institute of Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
- Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), München, Germany; VitalAire GmbH/Air Liquide S.A, Norderstedt b, Hamburg, Germany.
- Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), München, Germany.
- Institute of Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Munich, Member of the German Center for Lung Research (DZL), Munich, Germany; Institute of Experimental Pneumology, LMU University Hospital, Ludwig-Maximilians-University of Munich, München, Germany.
- Department of Internal Medicine, Division of Respiratory Medicine, Lung Research Cluster, Medical University of Graz, Graz, Republic of Austria.
- Asklepios Lung Clinic, Gauting, Germany; Institute of Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
- Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), München, Germany; Institute of Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Munich, Member of the German Center for Lung Research (DZL), Munich, Germany. Electronic address: Diego.KauffmannGuerrero@med.uni-muenchen.de.
摘要
中文
胸腔积液（PEs）在非小细胞肺癌（NSCLC）患者中常见，且具有预后意义。胸腔积液中检测到恶性细胞定义为转移性疾病。然而，PE细胞学灵敏度有限，大量PE细胞学阴性（Cyt-）。我们评估了细胞学阳性（Cyt+）和阴性积液的预后意义，并比较了NSCLC相关PE的生化、细胞和细胞因子谱。在这项对前瞻性收集的多中心队列研究的回顾性分析中，收集了2021年至2025年间确诊的NSCLC患者的PE。根据细胞病理学将积液分为Cyt+或Cyt-。记录临床数据、胸腔积液生化指标和差异细胞计数。使用多重ELISA panel检测PE上清液中的细胞因子浓度，并与生存期相关。本研究纳入111例NSCLC伴PE患者（51例Cyt+，60例Cyt-）。Cyt+积液的特征是pH显著降低，乳酸、LDH和蛋白浓度升高。两组的一年生存率无差异。高胸膜淋巴细胞计数和较低的胸膜中性粒细胞/淋巴细胞比率与死亡率相关。细胞因子分析显示Cyt+积液中IL-5水平显著降低，其他细胞因子相当。较高的Th2相关细胞因子水平（IL-4和IL-5）与改善的生存期相关，与细胞学状态无关。NSCLC相关细胞学阳性PE显示出独特的免疫学特征。Cyt+ PE患者的生存期与Cyt-积液患者相似。胸膜免疫组成，特别是淋巴细胞相关标志物和Th2细胞因子，可能提供细胞学之外的额外预后信息。
English
Pleural effusions (PEs) are frequent in patients with non-small cell lung cancer (NSCLC) and have prognostic implications. Detection of malignant cells in pleural fluid defines metastatic disease. However, PE cytology has limited sensitivity, leaving a substantial number of PEs cytology negative (Cyt-). We assessed the prognostic significance of cytology positive (Cyt+) and negative effusions and compared biochemical, cellular, and cytokine profiles of NSCLC associated PEs. In this retrospective analysis of a prospectively collected prospective multicenter cohort study, PEs were collected from patients with confirmed NSCLC between 2021 and 2025. Effusions were classified as Cyt + or Cyt - based on cytopathology. Clinical data, pleural fluid biochemistry, and differential cell counts were recorded. Cytokine concentrations were measured in PE supernatant using a multiplex ELISA panel and correlated with survival. 111 NSCLC patients with PEs were included in this study (51 Cyt + and 60 Cyt - cases). Cyt + effusions were characterized by significantly lower pH and higher lactate, LDH, and protein concentrations. One year survival was not different in both groups. High pleural lymphocyte counts and a lower pleural neutrophil to lymphocyte ratio were associated with mortality. Cytokine profiling revealed significantly lower IL-5 levels in Cyt + effusions, while other cytokines were comparable. Higher Th2 associated cytokine levels (IL-4 and IL-5) correlated with improved survival independent of cytology status. NSCLC-associated cytology positive PEs show distinct immunological features. Survival in patients with Cyt + PEs was similar to those with Cyt- effusions. Pleural immune composition, particularly lymphocyte related markers and Th2 cytokines, may provide additional prognostic information beyond cytology alone.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 5.3
- 新锐分区
- 2区