原发性肝癌TACE对外周血髓源性免疫抑制细胞百分比的影响

TACE reduces the percentage of myeloid-derived suppressor cell in peripheral blood of HBV-related primary liver cancer patients

为探讨肝细胞癌细胞增殖、临床分期、肝内转移以及经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)与髓源性免疫抑制细胞(myeloid-derived suppressor cell,MDSC)百分比的关系,收集2011年5月—2015年1月于石家庄市第五医院就诊的237例HBV相关原发性肝癌患者的临床资料,依据治疗方式分为TACE组(n=124)和非TACE组(n=113),分别于术前、术后采集患者外周静脉血检测G-MDSC(CD33^(+)/CD15^(+)/HLA-DR^(low)/CD11b^(+)),分析其百分比是否存在差异。结果显示,巴塞罗那临床肝癌(Barcelona Clinic Liver Cancer,BCLC)分期B组MDSC(22.03%)显著高于BCLC分期A组(14.12%)(P<0.05);肿瘤转移组MDSC百分比显著高于非转移组(21.03%vs 5.10%,P=0.011);肿瘤长径≥5cm组(27.53%)高于<5cm组(8.64%)(P>0.05);多发肿瘤组(19.21%)高于单发组(11.69%)(P>0.05);血管侵犯组(26.15%)高于非血管侵犯组(7.38%)(P<0.05);非TACE组MDSC(34.00%)高于TACE组(25.90%)(P<0.001);门静脉瘤栓组(13.41%)高于非瘤栓组(9.33%),但差异无统计学意义(P>0.05)。多因素分析结果显示BCLC分期、治疗方式是显著影响MDSC百分比的因素(均P<0.05)。对TACE治疗组124例患者的生存率进行为期24个月的观察,发现MDSC≥24.21%组与<24.21%组生存率差异显著(P<0.05)。由此,MDSC的百分比与肝癌BCLC分期等有关,TACE可显著降低MDSC百分比,后者与患者术后生存率有关。综上,针对MDSC的监测有助于提示肝癌的临床进展和疗效。

To investigate the relationship between HBV-related hepatocellular carcinoma cell proliferation,clinical stage,intrahepatic metastasis,transcatheter arterial chemoembolization(TACE)and the percentage of myeloid-derived suppressor cell(MDSC),the clinical data of 237patients with HBV-related primary hepatocellular carcinoma were collected from May 2011to January 2015at The Fifth Hospital of Shijiazhuang.They were divided into TACE group(124cases)and non-TACE group(113cases).Before and after operation,the peripheral venous blood test was executed to detect the percentages of G-MDSC(CD33^(+)/CD15^(+)/HLA-DR^(low)/CD11b^(+)).The results showed that the BCLC staging group B MDSC percentage(22.03%)was significantly higher than that of the BCLC staging group A(14.12%)(P<0.05);The MDSC percentage with tumor metastasis was significantly higher than the non-metastasis group(21.03%vs 5.10%,P=0.011);tumor diameter≥5cm group(27.53%)was higher than that of the<5cm group(8.64%)(P>0.05);The multifocal tumor group(19.21%)was higher than the monofocal group(11.69%)(P>0.05);The vascular invasion group(26.15%)was higher than the non-vascular invasion group(7.38%)(P<0.05);The non-TACE group(34.00%)was higher than TACE group(25.90%)(P<0.001);The tumor plug group(13.41%)was higher than that of the non-tumor plug group(9.33%),but the difference was not significant(P>0.05).Multivariate analysis showed that BCLC staging and the treatment modality were the factors that significantly affected MDSC percentages(all P<0.05).The survival rate of 124patients treated with TACE was observed for 24months.It was found that there was a significant difference between the MDSC≥24.21%group and the MDSC<24.21%group(P<0.05).Overall,the MDSC percentage is related to clinical indexes like BCLC staging.TACE significantly reduces MDSC percentage and is related to postoperative survival rate.Thus,MDSC monitoring helps to evaluate the clinical progression of HBV-related primary liver cancer patients and helps to improve disease outcome.