Objective：The aim of the study was to evaluate the ef icacy and safety of cytokine-induced kil er （CIK） cellcombined with transcatheter arterial chemoembolization （TACE） therapy in the treatment of hepatocellular...Objective：The aim of the study was to evaluate the ef icacy and safety of cytokine-induced kil er （CIK） cellcombined with transcatheter arterial chemoembolization （TACE） therapy in the treatment of hepatocellular carcinoma （HCC）. Methods：Randomized control ed trials （RCTs） on CIK cells combination with TACE based-therapy were identified by elec-tronic searches in the Cochrane Library, MEDLINE, Pubmed, Wanfang, VIP, CNKI and other electronic databases. We in-cluded any RCTs evaluating CIK cellcombination with TACE for the treatment of hepatocellular cancers. The quality of RCTs meeting inclusion criteria was evaluated and data on short-term and long-term curative ef ects, quality of life, liver function and immunologic function were extracted. For quantitative data, we conducted meta-analysis with ReMan 5.1 software and the GRADE System was used to rate the level of evidence and strength of recommendation. For qualitative data, data mainly adopted descriptive methods. Results：The 9 RCTs involving 870 cases meeting the inclusion criteria were included. The meta-analysis showed significant survival benefit on 0.5-year survival rate （RR=1.51, 95%CI, 1.35-1.69, P〈0.00001） in fa-vor of CIK based therapy. This ef ect was consistent at other prospective dates, including 1-year survival rate （RR=2.30, 95%CI, 1.94-2.72, P〈0.00001）, 2-year survival rate （RR=7.03, 95%CI, 3.83-12.91, P〈0.0001）. Meanwhile, the CIK-based group also demonstrated a significantly prolonged time-to-progression （TTP） （SD=1.62, 95%CI, 1.30-1.94, P〈0.0001） and overal survival （OS） （SD=20.6, 95%CI, 20.2-21.18, P〈0.0001）. Moreover, a favored response rate （RR=CR＋PR） （RR=2, 95%CI, 1.65-2.43, P〈0.00001） and the quality of life improvement rate （KPS） （RR=1.76, 95%CI, 1.26-2.45, P=0.0008） were also observed in patients receiving CIK cells and TACE therapy. Furthermore, patients in the CIK group showed lower AFP （SD=-165.23, 95%CI,-178.51--151.94, P〈0.00001）, ALT （SD=-33.14, 95%CI,-40.30--36.37, P〈0.00001）, and AST （SD=-15.57, 95%CI,-17.05--14.09, P〈0.00001） levels. In terms of T-lymphocyte subsets in peripheral blood, the analysis also showed the percentage of CD3＋, CD4＋cells and the ratio of CD4＋/CD8＋cells in the CIK group increased compared with the non-CIK group. Based on GRADE, the level of evidence was GRADE 2C, and the strength of recommen-dation was 2. Conclusion：CIK cells combined with TACE therapy demonstrated a significant superiority in improving recent and forward curative ef ects, immunity function, quality of life and liver function of HCC patients. Based on GRADE, the level of evidence was GRADE 2C, and the strength of recommendation was 2. In the light of the limitations of this study, large-scale, high-quality clinical trials should be carried out to further confirmed the above conclusion.展开更多
Objective: Epithelial-mesenchymal transition (EMT) is a critical early event for the invasion and metastasis of many carcinomas. In the present study, we examined EMT markers in the residual cancer cells of hepatocell...Objective: Epithelial-mesenchymal transition (EMT) is a critical early event for the invasion and metastasis of many carcinomas. In the present study, we examined EMT markers in the residual cancer cells of hepatocellular carcinoma (HCC) after radiotherapy. Methods: Eight patients with large HCC who underwent hepatectomy with preoperative radiothera- py were studied. The expressions of E-cadherin and vimentin were determined immunohistochemically in the residual cancer cells of HCC following radiotherapy, and also in the pre-radiotherapy biopsy cancer cells. Results: Histological analysis showed that some residual cancer cells of HCC displayed an elongated spindle or fibroblast-like shape. The expression of E- cadherin was markedly reduced or negative in the spindle residual cancer cells, but the expression of vimentin significantly in- duced. However, the above changes were not found in the pre-radiotherapy biopsy cancer cells. Conclusion: EMT is induced in the residual cancer cells of HCC following radiotherapy, which may facilitate the systemic dissemination of cancer cells.展开更多
基金Supported by a grant from the Natural Science Foundation of China(No.81000998)
文摘Objective：The aim of the study was to evaluate the ef icacy and safety of cytokine-induced kil er （CIK） cellcombined with transcatheter arterial chemoembolization （TACE） therapy in the treatment of hepatocellular carcinoma （HCC）. Methods：Randomized control ed trials （RCTs） on CIK cells combination with TACE based-therapy were identified by elec-tronic searches in the Cochrane Library, MEDLINE, Pubmed, Wanfang, VIP, CNKI and other electronic databases. We in-cluded any RCTs evaluating CIK cellcombination with TACE for the treatment of hepatocellular cancers. The quality of RCTs meeting inclusion criteria was evaluated and data on short-term and long-term curative ef ects, quality of life, liver function and immunologic function were extracted. For quantitative data, we conducted meta-analysis with ReMan 5.1 software and the GRADE System was used to rate the level of evidence and strength of recommendation. For qualitative data, data mainly adopted descriptive methods. Results：The 9 RCTs involving 870 cases meeting the inclusion criteria were included. The meta-analysis showed significant survival benefit on 0.5-year survival rate （RR=1.51, 95%CI, 1.35-1.69, P〈0.00001） in fa-vor of CIK based therapy. This ef ect was consistent at other prospective dates, including 1-year survival rate （RR=2.30, 95%CI, 1.94-2.72, P〈0.00001）, 2-year survival rate （RR=7.03, 95%CI, 3.83-12.91, P〈0.0001）. Meanwhile, the CIK-based group also demonstrated a significantly prolonged time-to-progression （TTP） （SD=1.62, 95%CI, 1.30-1.94, P〈0.0001） and overal survival （OS） （SD=20.6, 95%CI, 20.2-21.18, P〈0.0001）. Moreover, a favored response rate （RR=CR＋PR） （RR=2, 95%CI, 1.65-2.43, P〈0.00001） and the quality of life improvement rate （KPS） （RR=1.76, 95%CI, 1.26-2.45, P=0.0008） were also observed in patients receiving CIK cells and TACE therapy. Furthermore, patients in the CIK group showed lower AFP （SD=-165.23, 95%CI,-178.51--151.94, P〈0.00001）, ALT （SD=-33.14, 95%CI,-40.30--36.37, P〈0.00001）, and AST （SD=-15.57, 95%CI,-17.05--14.09, P〈0.00001） levels. In terms of T-lymphocyte subsets in peripheral blood, the analysis also showed the percentage of CD3＋, CD4＋cells and the ratio of CD4＋/CD8＋cells in the CIK group increased compared with the non-CIK group. Based on GRADE, the level of evidence was GRADE 2C, and the strength of recommen-dation was 2. Conclusion：CIK cells combined with TACE therapy demonstrated a significant superiority in improving recent and forward curative ef ects, immunity function, quality of life and liver function of HCC patients. Based on GRADE, the level of evidence was GRADE 2C, and the strength of recommendation was 2. In the light of the limitations of this study, large-scale, high-quality clinical trials should be carried out to further confirmed the above conclusion.
基金Supported by grants from the Natural Science Foundation of China (No.81000998)New Teachers Foundation of Ministry of Education of China (No. 20090141120003)
文摘Objective: Epithelial-mesenchymal transition (EMT) is a critical early event for the invasion and metastasis of many carcinomas. In the present study, we examined EMT markers in the residual cancer cells of hepatocellular carcinoma (HCC) after radiotherapy. Methods: Eight patients with large HCC who underwent hepatectomy with preoperative radiothera- py were studied. The expressions of E-cadherin and vimentin were determined immunohistochemically in the residual cancer cells of HCC following radiotherapy, and also in the pre-radiotherapy biopsy cancer cells. Results: Histological analysis showed that some residual cancer cells of HCC displayed an elongated spindle or fibroblast-like shape. The expression of E- cadherin was markedly reduced or negative in the spindle residual cancer cells, but the expression of vimentin significantly in- duced. However, the above changes were not found in the pre-radiotherapy biopsy cancer cells. Conclusion: EMT is induced in the residual cancer cells of HCC following radiotherapy, which may facilitate the systemic dissemination of cancer cells.
