自体DC-CIK细胞联合微波热凝治疗肝癌的疗效观察

Efficacy of the combined therapy with autologous dendritic cells-cytokine induced killer cells and percutaneous microwave coagulation for hepatocellular carcinoma

目的:观察自体DC-CIK细胞联合经皮微波热凝(percutaneous microwave coagulation therapy,PMCT)治疗肝癌的临床疗效。方法:收集2012年1月至2014年2月东方肝胆外科医院生物治疗科收治的44例行PMCT+DC-CIK治疗的肝癌患者(联合治疗组),先行血细胞分离单采并进行DC-CIK细胞培养,采血后第2天进行PMCT治疗;培养10 d后行CIK细胞回输及DC疫苗皮内注射。此后分别于1、2个月后行第2疗程及第3疗程DC-CIK细胞治疗。同时选取44例单纯行PMCT治疗的同期肝癌患者与之配对(对照组),该组患者仅行PMCT治疗。观察两组治疗前后的AFP变化、免疫功能、无进展生存期、总生存期及不良反应。结果:联合治疗组、对照组治疗后均有AFP下降及外周血调节性T细胞降低,但联合治疗组下降程度更显著(P<0.05);对照组治疗后外周血淋巴细胞亚群无明显变化(P>0.05),而联合治疗组则显著升高(P<0.05)。联合治疗组中位无进展生存时间及中位总生存时间均较对照组延长(7.1 vs 4.9个月;21.5 vs 14.0个月,均P<0.05)。结论:自体DC-CIK细胞联合PMCT是治疗肝癌的一种有效方法,可提高患者免疫功能、延缓肿瘤复发、延长生存期,且不良反应较少。

Objective: To evaluate the clinical efficacy of combined therapy using autologous dendritic cells-cytokine induced killer cells( DC-CIK) and percutaneous microwave coagulation( PMCT) in the treatment of hepatocellular carcinoma. Methods: Forty four patients with hepatocellular carcinoma treated with PMCT and DC-CIK( combination group)and 44 patients treated with PMCT alone( control group) were enrolled in the Department of Biotherapy of Eastern Hepatobiliary Surgical Hospital from January 2012 to February 2014. For patients in the combination group,peripheral blood mononuclear cells( PBMCs) were isolated on day 1 and PMCT were performed on the second day. After a ten day-culture,the DC- CIK cells were generated and transfused back to patients together with intradermal injection of DC vaccine.The second and third course of DC-CIK therapy were given one month and two months later respectively. The AFP level,immune function,progression-free survival,overall survival,and adverse effects were assessed for all the patients. Results: Although the level of AFP and regulatory T cells in peripheral blood decreased in the patients of both groups,their decline in the combination group was significantly more than that of the control group( P < 0. 05). Compared with that of pre-treatment,the lymphocyte number and subpopulations didn’t change significantly in the control group( P > 0. 05),but they did increase markedly in the combination group( P < 0. 05). The median progression-free survival and median overall survival were both increased in the combination group compared with that of the control group( 7. 1 m vs 4. 9 m,21. 5 m vs 14. 0 m,P < 0. 05). Conclusion: Adoptive transfer of autologous DC-CIK in combination with PMCT is an effective treatment for patients with hepatocellular carcinoma. It improves the immune function,postpones the recurrence of tumor,and prolongs the overall survival with acceptable toxicities.