化疗周期数对DC/CIK治疗晚期非小细胞肺癌临床效果的影响

The effect of chemotherapy cycles on efficacy of autologous DC/CIK cells immunotherapy in advanced non-small cell lung cancer patients

目的:研究化疗周期数对树突状细胞(DC)联合细胞因子活化的杀伤细胞(CIK)治疗晚期非小细胞肺癌(NSCLC)临床效果的影响。方法:回顾性分析2012年2至2016年2月内一科收治的124例化疗后接受DC/CIK治疗的晚期NSCLC患者的临床资料。患者按实际化疗周期分为2周期化疗组(43例)、3周期化疗组(40例)、4周期化疗组(41例)。3组患者临床资料及化疗方案相近。所有患者均在化疗后1～3个月内接受免疫细胞治疗。DC/CIK治疗前应用流式细胞仪检测外周血PD-1的表达。免疫细胞治疗完成后4周,参照RECIST标准和NCI-CTCAE 4.0标准评价近期临床疗效和安全性;根据卡氏(Karnofsky)功能状态评分评估患者生活质量(QOL)变化。结果:4周期化疗组PD-1表达水平明显高于2、3周期化疗组[(34.65±3.2 9)%vs (1 3.9 4±2.8 9)%和(25.88±5.06)%],差异有统计学意义(P <0.001)。2周期化疗组治疗的客观反应率(ORR) 27.91%显著高于4周期化疗组(9.76%)(P <0.05)。2周期化疗组疾病控制率(DCR) 34.88%显著高于4周期化疗组(14.63%),差异有统计学意义(P <0.05)。2周期化疗组QOL改善率55.81%,显著高于3周期化疗(32.50%)、4周期化疗组(21.95%)(P <0.05)。三组患者治疗后均未出现Ⅲ-Ⅳ级不良反应。结论:化疗周期数可降低DC/CIK对晚期非小细胞肺癌的临床治疗效果,化疗周期数越多病人取得DC/CIK细胞治疗的近期临床获益越小。

Objective:To evaluate the effect of chemotherapy cycles on efficacy of DC/CIK cells immunotherapy in patients with advanced non-small cell lung cancer. Methods:Clinical data of 124 patients received cell immunotherapy after chemotherapy,with advanced non-small cell lung cancer,were analyzed retrospectively.According to chemotherapy,patients were divided into 3 groups:2 chemotherapy cycles group (43 cases),3 chemotherapy cycles group(40 cases),4 chemotherapy cycles group (41 cases).The all groups were similar in the KPS and chemotherapy agents.Short-term clinical efficacy was evaluated according to RECIST criteria and safety according to NCI-CTCAE 4.0 criteria respectively 4 weeks after treatments were measured.The changes of patients' quality of life(QOL)were evaluated according to Karnofsky score. Results:The PD-1 levels in 4 chemotherapy cycles group was obviously higher than that in 2 and 3 chemotherapy cycles group [(34.65±3.29)% vs (13.94±2.89)% and (25.88±5.06)%, P <0.001].The clinical objective response rate (ORR) and disease control rate (DCR) in 2 chemotherapy cycles group were 27.91% and 34.88%,as compared with 17.50% and 25.00% in 3 chemotherapy cycles group ( P >0.05) and 9.76% and 14.63% in 4 chemotherapy cycles group ( P <0.05).The DCR of 3 chemotherapy cycles group was higher than that in 4 chemotherapy cycles group(25.00% vs 14.63%, P >0.05).The QOL improved rate 55.81% in 2 chemotherapy cycles group was significantly higher than that in 3 chemotherapy cycles group and in 4 chemotherapy cycles group ( P <0.05,respectively).No grade Ⅲ-Ⅳ adverse event happened in all cases. Conclusion:The data suggested that chemotherapy cycles potentially down regulated beneficial effects of DC/CIK cell immunotherapy.