腹腔内温热免疫化疗对胃及结直肠癌腹腔内复发的防治作用

Prophylactic and therapeutic effect of intraperitoneal thermochemoimmunotherapy on intraperitoneal recurrence of gastric and colorectal cancer after resection

目的评价腹腔内温热化疗合并白细胞介素-2(IL-2)免疫治疗对胃及结直肠癌术后腹腔内复发的治疗或预防作用。方法将1996年1月至1998年6月以来手术切除的35例T3Ⅱ～T4ⅢB期胃癌及111例B～D期的结直肠癌患者随机分成温热化疗组及联合免疫治疗组。温热化疗在手术后全麻下进行1h,化疗药为氟尿嘧啶(5-FU)0.5g/L,丝裂霉素(MMC)8mg/L,术后第3d行IL-2腹腔内免疫治疗。将IL-2100万U加入1000ml生理盐水中滴入腹腔,隔日进行,共10次,于免疫治疗的前后应用ELISA法测定两组患者外周血中几种主要Th1型细胞因子的水平,随访比较两组患者的生存率、腹腔内复发率及肝转移发生率,进行统计学分析。结果与温热化疗组相比,联合免疫治疗组的几种主要Th1型细胞因子的水平均明显升高,差异有非常显著性意义(P<0.01);3年生存率升高13.2%,而腹腔内转移率和肝转移发生率分别下降13.5%和6.2%,差异均有显著性意义(P<0.05～P<0.01)。结论腹腔内温热化疗合并免疫治疗可促进Th1型免疫漂移,增强机体的抗肿瘤免疫功能,对预防和治疗胃及结直肠癌腹腔内复发与肝转移有一定的作用。

Objective To investigate the prophylactic and therapeutic effect of intraperitoneal IL 2 immunotherapy following intraperitoneal thermochemotherapy on the metastasis and recurrence of gastric and colorectal cancer after operation. Methods Thirty five gastric cancer patients at T3Ⅱ～T4ⅢB stages and 111 patients of colorectal cancer at B to D stages from January 1996 to June 1998 were randomly divided into thermochemotherapy group (71 cases), and combined immunotherapy group (75 cases). For all the patients, distilled water at 43℃～45℃ containing 5 Fu 0 5 g/L and MMC 8 mg/L were perfused into peritoneal cavity for 1h before closure at the end of operation. For combined immunotherapy group, from the third day after operation, IL 2 one million U in 1 000 ml 0.9% sodium chloride was injected intraperitoneally for 10 times every other day. One month after operation, all the patients received regular intravenous chemotherapy. Before and after the IL 2 immunotherapy, some Th1 type cytokines in the peripheral blood of the patients in both groups were detected by ELISA, and the intraperitoneal recurrence, liver metastasis rate and 3 year survival rate were statistically evaluated after intensive follow up. Results IL 2 intraperitoneal immunotherapy elevated the levels of some Th1 type cytokines significantly as compared with those of thermochemotherapy group (P< 0 05). The 3 year survival rate of immunotherapy group increased by 13 2%; the rates of intraperitoneal recurrence and liver metastasis decreased significantly by 13 5% and 6 2% as compared with those of thermochemotherapy group(P< 0 05～P< 0 01). Conclusion Combination of intraperitoneal IL 2 immuno therapy and thermochemotherapy can promote Th1 immune paradigm and intensify anti tumor activity of body, which may play a positive role in preventing intraperitoneal recurrence and hepatic metastasis for gastric and colorectal cancer.