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经导管动脉栓塞化疗联合射频消融和细胞因子诱导的杀伤细胞输注治疗小肝癌

Effect of transcatheter arterial chemoembolization combined with radiofrequency ablation and cytokine-induced killer cells infusion on small hepatocellular carcinoma

摘要:

目的 探讨经导管动脉栓塞化疗(TACE)联合射频消融(RFA)后行自体细胞因子诱导的杀伤细胞(CIK)输注治疗对小肝癌的疗效.评价CIK细胞过继免疫治疗后患者免疫指标的变化.方法 2004年2月至2006年2月本院收治的小肝癌患者43例,分为两组,所有患者均行TACE联合RFA治疗.其中研究组患者21例,均完成4次以上自体CIK细胞输注治疗,每次回输CIK细胞的数量为(1.1~1.5)×1010m,检测研究组患者在CIK治疗前后外周血T淋巴细胞亚群及NK细胞水平的变化;对照组患者22例,未行CIK细胞过继免疫治疗.两组患者均每1~2个月评价肿瘤情况.结果 (1)对照组治疗后第1、2和3年的肝内累积复发率分别为9.1%、22.3%和27.3%;术后1、2和3年的生存率分别为95.5%、81.8%和68.2%.研究组第1、2和3年的肝内累积复发率分别是9.5%、14.3%和19.0%;术后1、2和3年的生存率分别为95.2%、85.7%和76.2%.两组生存率差异无统计学意义(P=0.558).(2)研究组CIK细胞治疗前后外周血T淋巴细胞亚群检测显示CD3+、CD4+、CD56+(NK)效应细胞的比例和CD4+/CD8+比值显著上升(P<0.05),CD8+和CD3+CD56+效应细胞比例下降(P<0.05).结论 TACE序贯联合RFA和CIK细胞过继免疫细胞治疗小肝癌可以提高患者的机体免疫水平,可能对降低肿瘤复发,延长小肝癌患者的生存期有一定作用.

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Objective To evaluate the efficacy of autologous eytokine-induced killer cells (CIKs) infusion after transcatheter arterial chemoembelization (TACE) combined with radiofrequency ablation (RFA) for patients with small hepatocellular carcinoma (SHCC) and the immunologic index changes of patients with SHCC after CIKs adoptive immunotherapy. Methods Forty-three patients with SHCC in our hospital from February 2004 to February 2006 were recruited and were divided into two groups after receiving TACE and CT-guided RFA. The study group (21 cases) received autologous CIKs infusion more than 4 times, and the number of CIKs infused ranged from 1.1×1010 to 1.5×1010 every time. The control group (22 cases) only received TACE combined with RFA. The levels of T lymphocyte subsets and native killer (NK) cells in peripheral blood of patients with SHCC in study group before and after CIKs infusion were detected. All the patients in both groups were evaluated every 1 to 2 months during follow-up. Results (1) 1-, 2-and 3-year intrabepatic accumulative recurrence rates in study group were 9.5%, 14.3% and 19.0% respectively, and those in control group were 9.1%, 22.3%and 27.3% respectively. 1-, 2- and 3-year survival rates in study group were 95.2%, 85. 7% and 76.2% respectively, and those in control group were 95.5%, 81.8% and 68.2% respectively (P=0.558). (2)The percentages of CD3+, CD4+ and CD56+ effect cells and the proportion of CD4+/CD8+ were obviously increased after CIKs infusion (P<0.05) ; while the percentages of CD8+ and CD3+CD56+ effect cells were decreased in study group(P<0.05). Conclusion Sequential CIKs infusion after TACE combined with RFA can improve immune function of patients with SHCC, and may play an important role in reducing recurrence rate of SHCC and prolonging the survival time.

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