DC-CIK过继免疫治疗联合化疗治疗晚期结直肠癌的临床研究

Clinical efficacy of DC-CIK immunotherapy combined with chemotherapy in treatment of advanced colorectal cancer

目的探讨树突状细胞联合细胞因子诱导的杀伤细胞(DC-CIK)过继免疫治疗联合化疗治疗晚期结直肠癌的疗效及安全性。方法 2010年1月至2013年12月确诊的235例晚期结直肠癌患者,按随机数字表法分成两组,DC-CIK组124例患者行DC-CIK过继免疫治疗联合化疗,单纯化疗组111例患者行单纯化疗,评价两组患者治疗后免疫功能、疗效、生存期、不良反应以及生活质量等。结果治疗3个周期后,DC-CIK组患者的CD3^+、CD3^+CD4^+、CD3^+CD8^+、NK、NKT、Treg,CD4^+T细胞以及CD4^+T细胞内IFN-γ、IL-2、TNF-α等指标与治疗前比较均无统计学差异(均P>0.05);患者的中位无进展生存期(PFS)为7.0个月(95%CI=6.4~7.6),中位总生存期(OS)为14.5个月(95%CI=13.4~15.6),与单纯化疗组比较均有统计学差异(均P<0.01)。DC-CIK组患者的Ⅲ~Ⅳ度不良反应中,血白细胞下降的发生率为22.0%(11/50),低于单纯化疗组(P<0.05)。DC-CIK组治疗前后生活质量评分分别为(51.1±6.2)和(62.3±5.2)分,比较有统计学差异(t=15.413,P<0.01)。结论 DC-CIK过继免疫治疗联合化疗能够明显改善晚期结直肠癌患者的免疫功能,提高患者生存期及生存质量,而且不良反应少、安全性高。

Objective To investigate the efficacy and safety of DC-CIK （dendritic cell-cytokine induced killer cell） immunotherapy combined with chemotherapy for advanced colorectal cancer. Methods Two hundred and thirty five patients with advanced colorectal cancer admitted in Affiliated Jiangyin Hospital of Southeast University Medical College from January 2010 to December 2013 were enrolled in the study. Patients were randomly assigned in two groups, 124 cases received DC-CIK combined with chemotherapy（DC-CIK group）, and 111 cases received routine chemotherapy（chemotherapy group）. The immune function, efficacy, survival, toxicity and quality of life were evaluated and compared between two groups. Results After 3 cycles of treatment, no significant difference was observed between 2 groups regarding CD3^＋, CD3^＋CD4^＋, CD3^＋CD8^＋, NK, NKT, Treg, CD4^＋T cells, IFN-y ,IL-2,TNF-α index and other indicators （all P 〉0.05）. Log-Rank test showed that the median progress-free survival （PFS） （7 months, 95%C1=6.4-7.6） and median overall survival （OS） （14.5 months, 95%C1=13.4-15.6） in DC-CIK group were significantly longer than those in chemotherapy group（both P〈0.01）. The incidence of leukopenia （22.0%, 11/50） in DC-CIK group was lower than that in chemotherapy group （P〈0.05）. The quality of life scores in DC-CIK group were increased from 51.1 ± 6.2 before treatment to 62.3 ± 5.2 after treatment （t= 15.413, P〈0.01）. Conclusion DC-CIK immunotherapy combined with chemotherapy can significantly improve immune function, progression-free survival and overall survival and the quality of life for patients with advanced colorectal cancer.