CD4+和CD8+T细胞凋亡对乳腺癌保乳术后放疗不良反应的预测价值OA

Objective This study aims to explore the potential of CD4+and CD8+T lymphocyte apoptosis as biomarkers for predicting radiation-induced adverse effects in the breast following breast-conserving surgery(BCS)and subsequent simultaneous integrated boost hypofractionated radiotherapy(HFRT)for breast cancer.Methods Clinical data from 72 patients who underwent BCS followed by concurrent boost HFRT at Tangshan People's Hospital from July 2020 to September 2021 were collected.The severity of radiation-induced adverse effects in the breast was assessed according to common terminology criteria for adverse events.Fresh blood samples were collected,exposed to 8Gy X-ray irradiation,and analyzed using flow cytometry to evaluate CD4+and CD8+T lymphocyte apoptosis.Additionally,pre-and post-radiotherapy breast tissue samples were extracted for immunohistochemical analysis to assess CD4+and CD8+T cell infiltration.Cox regression was used to analyze the factors influencing the degree of adverse reactions.Spearman correlation analysis was used to evaluate the relationship between lymphocyte apoptosis and the severity of adverse effects.Receiver operating characteristic(ROC)curve analysis was employed to assess the predictive value of CD4+and CD8+T lymphocyte apoptosis for breast-related radiation adverse effects.The 2-year cumulative incidence rates of different lymphocyte apoptosis levels were compared,and multivariate regression analysis was used to adjust for potential confounding factors.Results A total of seventy two patients were followed up for at least 2 years.There were fifty one patients(70.8%)with grade≤1 and twenty one patients(29.2%)with grade≥2 breast related adverse reactions,respectively.The proportion of diabetes history and T2 stage in patients with≤grade 1 was higher than that in patients with≥grade 2,and the radiation induced lymphocyte apoptosis(RILA)level of CD8+T cell and CD4+T cell were higher than that in patients with≥grade 2,with statistical significance(P<0.05).Cox regression results showed that T stage(OR=11.143,95%CI:1.703-72.908),CD8+T cell RILA level(OR=0.273,95%CI:0.157-0.473)and CD4+T cell levels(OR=0.211,95%CI:0.103-0.431)were independent influencing factors for the degree of adverse reactions(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of CD8+T cell RILA to predict grade 2 breast related adverse radiation reactions was 0.947(95%CI:0.806-1.000),and the AUC of CD4+T cell RILA was 0.824(95%CI:0.654-1.000).,the difference was statistically significant(P<0.05).Conclusions CD8+T lymphocyte apoptosis,along with associated immune cell infiltration and gene expression changes,holds significant predictive value for radiation-induced adverse effects in the breast following BCS and SBRT for breast cancer.Integrating CD8+T cell apoptosis and immunohistochemical data can further enhance the predictive capability for radiotherapy-related risks and provide reference for personalized radiotherapy and prevention strategies.