细胞因子诱导杀伤细胞过继免疫联合化疗治疗食管癌的Meta分析

Cytokine-induced killers of adoptive immunotherapy combined with chemotherapy for the treatment of esophageal cancer:A Meta-analysis

目的:评价细胞因子诱导杀伤细胞(CIK)过继免疫联合化疗治疗食管癌的临床疗效。方法:计算机检索CNKI、CBM、VIP、WanFang、Cochrane Library、PubMed、Embase、Web of Science,收集所有CIK细胞过继免疫联合化疗治疗食管癌的相关研究,检索时限为建库至2020年02月20日,由两位评价员独立筛选文献和提取资料,并对纳入的研究进行质量评价,使用RevMan5.3软件进行分析。结果:共纳入13篇文献,包括1134例患者。Meta分析结果示,联合组客观缓解率(ORR)、疾病控制率(DCR)、生活质量改善率(QLIR)均高于单纯化疗组[OR=2.52,95%CI(1.75,3.61);OR=3.53,95%CI(2.48,5.02);OR=3.31,95%CI(2.26,4.85),P<0.05];联合组治疗后T淋巴细胞亚群中CD3^(+)、CD3^(+)CD16^(+)CD56^(+)比例平均较单纯化疗组有所增加[SMD=1.69,95%CI(1.15,2.23);SMD=1.61,95%CI(1.13,2.10),P<0.05];联合组治疗后IL-2、IL-12、TNF-α等细胞因子平均水平高于治疗前[SMD=2.37,95%CI(1.88,2.86);SMD=5.69,95%CI(4.83,6.55);SMD=3.51,95%CI(2.24,4.78),P<0.05];外周血肿瘤标记物SCC及Cyfra21-1平均浓度较治疗前明显下降[SMD=-4.23,95%CI(-5.40,-3.05);SMD=-3.66,95%CI(-6.66,-0.65),P<0.05];联合组与单纯化疗组不良反应比较中白细胞减少、胃肠道反应及末梢神经炎方面发生率变化不明显且均无统计学差异(P>0.05)。结论:CIK细胞过继免疫联合化疗能提高食管癌患者的临床疗效、改善生活质量、增强免疫应答能力,协同化疗增强抗肿瘤效果。

Objective:To evaluate the clinical efficacy of cytokine-induced killers(CIK)of adoptive immunotherapy combined with chemotherapy for the treatment of esophageal cancer.Methods:CNKI,CBM,VIP,WanFang,Cochrane Library,PubMed,Embase,Web of Science were searched to identify studies on CIK of adoptive immunotherapy combined with chemotherapy for EC up to February 20th,2020.After independently screening the literature and extracting data,two researchers evaluated the quality of the included studies,and analyzed them with RevMan5.3 software.Results:A total of 13 studies involving 1134 patients were included.Meta-analysis showed that the objective response rate(ORR),disease control rate(DCR)and quality of life improvement rate(QLIR)in the combined treatment group were higher than those in the chemotherapy group[OR=2.52,95%CI(1.75,3.61),OR=3.53,95%CI(2.48,5.02),OR=3.31,95%CI(2.26,4.85),P<0.05].The ratios of CD3^(+)and CD3^(+)CD16^(+)CD56^(+)cells in the combined treatment group were increased than those in the chemotherapy group[SMD=1.69,95%CI(1.15,2.23),SMD=1.61,95%CI(1.13,2.10),P<0.05].Compared with the group of before treatment,the average level of IL-2,IL-12 and TNF-αin the combined treatment group was higher[SMD=2.37,95%CI(1.88,2.86),SMD=5.69,95%CI(4.83,6.55),SMD=3.51,95%CI(2.24,4.78),P<0.05]and the average concentration of SCC and Cyfra21-1 in peripheral blood was significantly lower[SMD=-4.23,95%CI(-5.40,-3.05),SMD=-3.66,95%CI(-6.66,-0.65),P<0.05].There was no significant difference in the incidence of leucopenia,gastrointestinal reaction and peripheral neuritis between the combined treatment group and the chemotherapy group(P>0.05).Conclusion:CIK cells of adoptive immunotherapy combined with chemotherapy can improve the clinical efficacy of esophageal cancer patients,improve their quality of life and enhance their immune response.