重组改构人肿瘤坏死因子治疗恶性胸腔积液的疗效及其在其中的价值

Efficacy and value of recombinant human tumor necrosis factor in the treatment of malignant pleural effusion

目的探讨重组改构人肿瘤坏死因子(rmh TNF)对恶性胸腔积液(MPE)的疗效,分析胸腔积液中肿瘤细胞CD133表达情况对重组改构人肿瘤坏死因子疗效和预后的影响。方法选择伴有恶性胸腔积液的肿瘤患者38例作为研究对象,应用rmh TNF300万IU胸腔灌注,3 d一次,3到4次为一个疗程;治疗前收集10 ml胸腔积液,检测肿瘤细胞CD133的表达情况,分析rmh TNF治疗MPE疗效、预后的影响因素及与CD133的关系。结果 38例患者中,CR病例0例,PR病例16例,SD病例18例,PD病例4例;总的ORR为42.11%,总的DCR为89.47%,PFS中位数为2月,OS中位数为4月; PS评分(0～1)的患者较PS评分(2～3)的患者的DCR高,差别具有统计学意义; Rmh TNF联合全身化疗的患者较Rmh TNF单药治疗的患者ORR和DCR高,PFS和OS长;治疗前22例患者恶性胸水中检测出CD133+肿瘤细胞,16例患者治疗前胸水中未检测出CD133+肿瘤细胞。胸水中未检测出CD133+肿瘤细胞的患者ORR及DCR较检测出CD133+的患者要高;胸水中未检测出CD133+肿瘤细胞的患者PFS及OS较检测出CD133+的患者长。结论胸水中检测出CD133+肿瘤细胞是应用rmh TNF治疗MPE患者不利的因素,另外在条件允许的情况下采用rmh TNF胸腔灌注联合全身化疗治疗MPE能取得较rmh TNF单药胸腔灌注更好的疗效和预后。

Objective To investigate the clinical efficacy of rmhTNF in the treatment of malignantpleural effusion and investigate the relationship between CD133 with efficacy and prognosis of MPE patientstreated by rmhTNF. Methods 38 cases of malignant tumor with malignant pleural effusion were selected as thestudy subjects. RmhTNF was infused intralpeurally at a dose of 300 KU each time and 3-4 times was regarded asone course. 10 ml pleural effusion was collected before treatment to detect the expression of CD133 of tumorcells and to analyze the effect and prognosis of MPE treated with rmhTNF and the relationship with CD133.Results Among the 38 patients, there were 0 cases of CR, 16 cases of PR, 18 cases of SD, 4 cases of PDand 42.11% of total ORR. The total DCR was 89.47%.The median of PFS was 2 month, and the median of OSwas 4 month. Patients with PS score （ 0-1） had higher DCR than patients with PS score （ 2-3）, and thedifference was statistically significant. Patients treated with RmhTNF combined with systemic chemotherapy werehigher than those of RmhTNF monotherapy in ORR and DCR, PFS and OS were longer. CD133＋tumor cells were detected in 22 patients with malignant pleural effusion before treatment, and CD133＋tumor cells were notdetected in 16 patients with malignant pleural effusion before treatment; ORR and DCR in patients with pleuraleffusion did not detect CD133＋tumor cells were higher than those detected in CD133＋patients; PFS and OS inpatients without CD133＋tumor cells in pleural effusion were longer than those detected in CD133＋patients.Conclusion CD133＋is an unfavorable factor in the application of rmhTNF in the treatment of MPE patients.In addition, the combination of rmhTNF pleural perfusion combined with systemic chemotherapy can achieve abetter curative effect and prognosis than the rmhTNF single drug to treat MPE.