肿瘤坏死因子和N－CWS介入性治疗中晚期肝癌的临床与二步切除研究

Using TNF and N-CWS in Interventional therapy Combinded with Two-Stage Resection in Treatment of Moderate or Advanced Hepatic Carcinoma

目的研究肿瘤坏死因子和Ｎ－ＣＷＳ介入性治疗中晚期肝癌的临床与二步切除。方法２３２例中晚期肝癌随机分为免疫化疗栓塞组（治疗组）８０例，化疗栓塞组（对照组）１５２例，二组病期相似，均行肝动脉化疗栓塞，注入相向化疗方案和剂量（５－氟尿嘧啶、顺铂和阿霉素或丝裂霉素），用碘化油和明胶海棉为栓塞剂。治疗组同时配合肿瘤坏死因子和Ｎ－ＣＷＳ免疫治疗。结果治疗组１３例（１６．２％）、对照组１９例（１２．５％）行二步切除术，治疗组的肿瘤缩小率和二步切除率均比对照组高，治后１年、２年和３年生存率分别比对照组提高９．３％，８．６％和１１．０％（Ｐ＞０．０５）。免疫功能治疗组下降不明显（Ｐ＞０．０５），而对照组明显下降（Ｐ＜０．０５）。结论肿瘤坏死因子和Ｎ－ＣＷＳ介入性治疗能提高患者的免疫功能，延长生存期，具有广泛的应用前景。

To study the use of TNF and NCWS combinded with two-stage resection of moderate or advanced hepatic carcinoma.Methods 232 patients withmoderate or advanced stage of hepatic carcinoma were treated in our hospital.80 cases were randomly distributed into immuno-chemo-embolization group and another 152 cases into chemo-embolization group(control).There was no apparent difference of clinical stage between the two groups.These two groups were received the same chemo-therapeutical regime plus embolization.Tumour necrosis factor(TNF)500 kU and nocardia rubra cell wall skeleton(N-CWS)400μg were given as an immuno-therapeutical agent at the same time in the therapeutical group.13 patients(16.2%)were undergone two-stage resection in therapeutical group.Whereas 19 patients(12.5%)undergone resection in control group.Results(1)Tumour shrinkage rate and two-stage resection rate in therapeutical group were higher than those in control group.(2)In therapeutical group,1-year,2-year and 3-year survival rate were increased up to 9.3%,8.6% and 11.0% respectively from those of control group but these was no significant difference between these two groups(P>0.05).(3)The patients immunofunctions were not markedly decreased in therapeutical group.However,immunofunctions were considerably decreased in control group after treatment(P<0.05).Conclusion TNF and N-CWS are capable of enhancing patients systemic immunofunction of patients during treatment for moderate or advanced hepatic cancer.