肝动脉化疗栓塞联合深部热疗治疗原发性肝癌的临床研究

Study for Primary Hepatic Carcinoma Treated with Transcatheter Arterial Chemoembolization in Adjuvant with Thermotherapy.

目的探讨肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合深部热疗治疗原发性肝癌(primaryhepatic carcinomas,PHCs)的疗效;治疗前、后患者T细胞亚群和NK细胞的变化及其临床意义。方法将40例晚期PHCs随机分为TACE联合深部热疗组(研究组)和单纯TACE(对照组),每组各20例。研究组采用TACE联合深部热疗治疗,于TACE后第1天开始热疗,隔天1次,共5次;对照组采用单纯TACE治疗。对比分析2组病例肿瘤体积变化及1年生存率。采用免疫荧光染色法,检测20例原发性肝癌患者TACE联合深部热疗前后T细胞亚群及NK细胞的变化,并与20例常规介入化疗栓塞组(非热疗组)进行比较。结果研究组和对照组近期缓解率分别为65%和40%(P<0.05);1年生存率分别为55%和35%(P<0.05)。治疗后2周检测,热疗组CD4^+、CD4^+/CD8^+及NK细胞明显高于非热疗组,差异有统计学意义(P<0.05)。结论 TA-CE联合深部热疗可以显著提高PHCs的近期疗效和1年生存率。TACE联合深部热疗能快速增加血液中T淋巴细胞及NK细胞的数量,抵消常规介入引起的免疫功能下降,对控制肿瘤的转移可能起到积极的作用。

Objective To evaluate the efficacy of transcatheter arterial chemoembolization （TACE） in adjuvant with ther - motherapy in the treatment of primary hepatic carcinomas （PHCs） ,and to obsorre the changes of T -lymphocyte subsets and naturalkiller（NK） cells before and after therapy and the clinical significance. Methods Forty patients with advanced PHCs were randomly divided into two groups （the study group and the control group） ,with 20 cases in each. The patients in the study group were treated by TACE in adjuvant with thermotherapy, and the patients in the control group were treated by TACE alone. The changes of T - lymphocyte subsets and NK cells were examined by im- munofluorescence staining in 40 cases of PHC before and after TACE in adjuvant with ther - motherapy and were compared with those of 20 cases who received conventional interventional chemotherapy （control group）. Results The short - term remission rate of the study group and control group were 65% and 40% , respectively （P 〈 0.05）. The survival rate of both groups at 1 year were 55% and 35% , respectively （P 〈0.05）. At two weeks after treatmen,the levels of CD4^＋ ,CD8^＋ T - lymphocytes, the ratio of CD4 ^＋/CD8 ^＋ , and the numberof NK cells in thermoehemotherapy groups were obviously higher than those in the control group （P 〈 0.05 ）. Conclusion TACE in adjuvant with thermotherapy might obviously enhance the short - term curative effect of primary hepatic carcinoma and 1 year survival rate. TACE in adjuvant with ther - motherapy rapidly increases the number of T - lym - phocytes and NK cells in the peripheral blood and effectively antagonizes the decrease induced by conventional interventional chemotherapy, which plays a positive role in controlling tumormetastasis.