胃癌术后癌性腹水的免疫化学治疗

Immunochemotherapy in patients with malignant ascites following curative resection of gastric cancer

目的观察短棒状杆菌联合替加氟、奥沙利铂腹腔内灌注治疗胃癌术后癌性腹水的疗效和细胞免疫功能的变化。方法41例胃癌术后癌性腹水患者随机分成两组:(1)单纯化疗组,20例,用替加氟、顺铂行腹腔灌注化疗;(2)腹腔免疫化疗组,21例,采用腹腔注射短棒状杆菌联合替加氟、顺铂治疗。用B超测定患者治疗前后腹水消退率,用流式细胞仪检测患者外周静脉血T细胞亚群(CD3+、CD4+、CD8+和CD4+/CD8+)和NK细胞。结果腹腔免疫化疗组有效率100%,其中CR19例(90.1%),PR2例(9.5%);单纯化疗组有效率60.0%,其中CR2例(10%),PR10例(50%)(P<0.01);免疫化疗组治疗后的外周血T细胞CD3+、CD4+、CD4+/CD8+比值和NK细胞数较治疗前明显上升(P<0.01),而腹腔化疗组治疗前后外周血的T细胞CD3+、CD4+、CD4+/CD8+比值和NK细胞数无明显变化(P>0.05)。结论短棒状杆菌联合替加氟、奥沙利铂腹腔免疫化疗可以改善患者机体的细胞免疫功能,明显提高癌性腹水的治疗效果。

Objective To investigate the efiqciency of intraperitoneal immunochemotherapy for patients with malignant ascites following curative resection of gastric cancer. Methods Forty-one patients with malignant ascites following curative resection of gastric cancer were randomized into 2 groups ： （ 1 ） intraperitoneal chemotherapy （ICT） group with cisplatin and tegafur（ n = 20） ; （2） intraperitoneal immunochemotherapy（IICT） with corynebacterium parvum preparations, cisplatin and tegafur（ n = 21 ）. Ultrasenography was used to measure the extent of ascites before and after the treatment. T lymphocyte subsets（ CD3^＋ , CD4^＋ , CD8 ^＋ and CD4^＋/CD8^＋ ） and NK cells in peripheral blood were examined with flow cytometry. Results Remission rate in IICT group was 100%, of which complete remission rate（CR） was 90.1%, partial remission rate（PR） was 9.5% ; Remission rate in ICT group was 60%, of which complete remission rate was 10%, partial remission rate was 50%. T lym- phocyte subsets CD3^＋ , CD4^＋ , CD4^＋/CD8^＋ and NK cells were all significantly increased in IICT group after intraperitoneal immunochemotherapy （ P 〈 0.01 ）, but there was no significant change in ICT group（ P 〉 0.05 ）. Conclusion It was suggested that intraperitoneal immtmochemotherapy is a safe and effective treatment for the malignant ascites following curative resection of gastric cancer.