Адаптивый иммунный ответ в патогенезе и лечении плоскоклеточного рака головы и шеи: влияние факторов иммуносупрессии и гендерных особенностей

Очевидной тенденцией последнего десятилетия в изучении патогенеза плоскоклеточного рака головы и шеи является осознание значимости нарушений иммунного ответа в развитии этого заболевания. В обзоре представлен анализ различий типа и степени иммуносупрессии, а также ответа на консервативное лечение у больных плоскоклеточным раком головы и шеи в зависимости от влияющего канцерогенного фактора, пола, возраста и сопутствующих заболеваний. В исследованиях показано, что у курящих и злоупотребляющих алкоголем пациентов с данным заболеванием обнаружено увеличение CD8⁺-т-лимфоцитов и снижение т-клеток памяти, а в микроокружении опухоли выявлено меньшее количество CD8⁺-т-лимфоцитов по сравнению с некурящими и непьющими пациентами. лучший прогноз у больных плоскоклеточным раком головы и шеи, ассоциированным с вирусом папилломы человека, в значительной степени обусловлен наличием антител к е6 и е7 этого вируса, е7-специфичных CD8⁺-т-лимфоцитов в периферической крови и высоким уровнем опухоль-инфильтрирующих т-лимфоцитов. широко обсуждается вопрос гендерных различий в типе иммунного ответа. показано, что применение ингибиторов контрольных точек иммунного ответа в монорежиме более эффективно в отношении улучшения показателей выживаемости у мужчин, а использование этих препаратов в сочетании с химиотерапией – у женщин. Кроме того, у пожилых онкологических пациентов выявлены многочисленные возраст-ассоциированные повреждения функций т-лимфоцитов, в том числе снижение количества наивных т-лимфоцитов из-за возрастной инволюции тимуса и повышение относительного количества клеток памяти и эффекторных клеток.

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