进展期胃癌术后自身CIK细胞和树突状细胞联合治疗的临床观察

Clinical Observation of Co-treatment with Autologous CIK Cells and Dendritic Cells for Postoperative Advanced Gastric Carcinoma

目的:评估进展期胃癌术后用CIK细胞联合树突状细胞(DC)治疗的疗效。方法:将110例进展期胃癌术后患者随机分为两组。1)细胞免疫治疗组52例:常规诱导培养患者自身CIK和DC,再将培养的自身CIK细胞回输,DC给予患者腹股沟、腋下浅表淋巴结内和淋巴结附近皮下注射以及静脉回输;患者1个疗程接受CIK细胞总数在1.1～8.0×10^(10)之间,DC总数在3～7×10~7之间。每周回输CIK细胞2次,8～12次为1个疗程,3～6个月后行第2次治疗:每例患者每个疗程接受3～5次成熟DC注射。2)化疗组58例:全部采用CF+5-FU+ADM+DDP方案,3例治疗2个周期,6例治疗3个周期,49例治疗4个周期以上。结果:细胞免疫治疗组(Ⅰb、Ⅱ和Ⅲa)中,3年生存率为86.8% (33/38),5年生存率为78.9%(30/38),化疗组分别为65.1%(28/43)、53.5%(23/43),细胞免疫治疗组生存率明显高于化疗组。细胞免疫治疗后患者食欲增加、疼痛减轻、睡眠改善、体重增加较化疗组明显。CEA增高患者治疗后恢复正常高于化疗组。结论:进展期胃癌术后的自身CIK细胞和树突状细胞(DC)联合治疗组(Ⅰb、Ⅱ和Ⅲa)3、5年生存率明显高于化疗组,细胞免疫治疗能改善患者细胞免疫功能和临床体征,无不良反应,对进展期胃癌术后防止复发是一种安全有效的治疗方法。

Objective： To evaluate the therapeutic effect of cytokine-indueed killer （CIK） cells in combination with dendritic cells on postoperative advanced gastric careinoma. Methods： 110 patients with postoperative advanced gastric cancer were randomized into two groups. 1） The cellular immunotherapy group consisted of 52 patients. Mononuelear cells from peripheral blood of the subjects were isolated and euhured with cytokines to produce mature DC and CIK-eells, and the autologous CIK cells were re-infused into the patients. DC were injected into groin, axillary lymph nodes, a subeutaneous site near lymph nodes or intravenously. The patients were given approximately 1.1-8.0×10^10 CIK cells and about 3-7×10^7 DC, two times per week, cycling for 4-6 weeks until all of the patients were given the second treatment consisting of chemotherapy. 2） All of the patients received chemolherapy consisting of CF＋5-FU＋ADM＋DDP. Three patients received 2 cycles, 6 received 3 eyeles, forty-nine received more than 4 cycles. Results： In the group treated by cellular immunotherapy, the 3-year survival rate was 86.8% （33/38）, and the 5-year survival rate was 78.9% （30/38）. The 3-year survival rate of the chemotherapy group was 65.1% （28/43）, and the 5-year suurvival rate was 53.5% （23/43）. The recovery rate in high-CEA patients with immunotherapy was much higher than those with chemotherapy. Conclusion： Treatment with autologous-CIK cells in combination with dendritic cell therapy shows higher 3-year and 5-year survival rates than routine chemotherapy for postoperative advanced gastric cancer patients. Immunotherapy improves cellular immune function and clinical symptoms without side effects. It is a safe and effective adjuvant therapy for advanced gastric carcinoma.