摘要
目的动态观察手术、化疗、免疫制剂对围手术期胃癌患者免疫功能的影响,并通过远期随访,探讨干扰素α1b(IFN-α1b)在胃癌综合治疗中的作用。方法获根治的49例胃癌患者分为:A组(单纯手术组,术前7天至术后4周内未给予化疗或IFN-α1b,10例);B组(化疗组,应用5-Fu,18例);C组(免化组,5-Fu+IFN-α1b,21例)。分别于术前,术后2周、4周、6周检测T细胞亚群(CD4、CD8)及NK细胞,监测肿瘤标志(TMs,包括胃癌抗原MG7、CEA、CA19-9),并对部分病例(应用IFN-α1b的IFN组,12例;对照组CTL组,包括单纯手术组及化疗组,11例)随访。结果胃癌患者术前免疫功能降低,术后短期内进一步削弱;化疗可损害免疫功能,加用IFN-α1b治疗6周以上可减轻免疫损伤;MG7的阳性率是69.4%,可作为判断预后的指标;术前TMs升高者术后短期内MG7下降,如联检则部分患者于术后3月TMs再度升高,但组间无差别;IFN组与CTL组的中位生存时间分别为44个月及30个月,但组间无差异(P=0.5641)。结论IFN-α1b可减轻化疗对机体的免疫损伤,但需较长时间才能发挥作用;IFN-α1b对胃癌患者的生存时间无明显影响;MG7在胃癌术后监测及随访方面有肯定价值。
Objective To investigate the effects of operation, chemotherapy （5-fluorouracil,5-Fu） and immunotherapy （interferon alpha-1b, IFN-α1b） on the cellular immunity function of perioperative patients with gastric carcinoma, and to explore the role of IFN-α1b in combined therapy of gastric carcinoma. Methods Forty-nine patients who had undergone surgical resection were assigned at random to 3 groups ： 1. Group A： operation group （no chemotherapy or IFN-cd b given during 7 days before to 28 days after operation, n = 10 ） ; 2. Group B ： chemotherapy group （5-Fu 0. 5 - 0. 75 mg iv. drip daily × 3/week, n = 18 ） ; 3. Group C： immunotherapy group （IFN-cdb, 3 M.U.i. m daily × 3/week, in combination with 5-Fu, n = 21 ）. T cell subsets（ CIM, CD8, CIM/CD8）and NK cells were determined preoperatively and on the 14^th, 282 and 42nd postoperative days, and tumor markers （ TMs, including gastric cancer antiger MG7, CEA and CA,9.9 ） were monitored. Five year follow-up results were obtained in some cases of IFN group who received IFN-cdb （n = 12） and CTL group （control group, n = 11 ）. Results 1. CD4, CD4/CD8 and NK cells in patients with gastric carcinoma were lower than normal and decreased further in a short postoperative period 2. Treatment with IFN-α1b for at least 6 weeks could abrogate 5-Fu-induced suppression of cellular immunity. 3. Positive rate of MGTwas 69.4% and could be used as an index for judging prognosis. Those who has preoperative increase in TMs showed short-term postoperative decrease in MG7. In some patients, TMs rose again 3 months after operation. 4. Median survival time was 44 months in IFN group and 30 months in CTL group, respectively （ P = 0. 5641 ）. Conclusion 1. 5-Fu in combination with IFN-α1b for at least 6 weeks can alleviate 5-Fu-induced immuno suppression and this regimen shows its feasibility and safety; 2. IFN-α1b does＇not change median survival time of patients with gastric carcinoma. 3. postoperative monitoring of MG7 is valuable to the jud
出处
《中国肿瘤临床与康复》
2008年第3期193-196,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
