摘要
目的探讨免疫化疗栓塞术（ICE）预防肝癌术后复发转移的机制，确定ICE的预防价值。方法选择146例可手术的原发性肝癌患者，随机分为：A组单纯手术，B组术后肝动脉化疗栓塞术（TACE），C组术后 ICE。A组常规方法行肝癌切除术，术后予对症支持治疗；B组术后1个月行TACE，方案为阿霉素＋顺铂＋5氟尿嘧啶＋碘化油；C组方案改为阿霉素＋顺铂＋5氟尿嘧啶＋碘化油＋奥曲肽＋干扰素，余同B组。分别测定外周血T细胞亚群，A组患者入院后第2天、术后1周、1个月；B组患者TACE术前、术后1周、1个月；C组患者免疫化疗栓塞术前、术后1周、1个月。酶联免疫吸附测定法测定所有患者术前、术后1天、术后1个月，介入治疗术后第1、3、7、14天及1个月的外周血血管内皮生长因子（VEGF）值。统计各组1、2、3年的复发率及生存率。结果原发性肝癌患者术前CD3^＋、CD4^＋、CD4^＋／CD8^＋均较低，而术后1个月各项指标升高。TACE术后1周CD3^＋、CD4^＋、CD4^＋／CD8^＋均降低，CD8^＋升高；而1个月后CD3^＋、CD4^＋、CD4^＋／CD8^＋均升高，CD8^＋降低（P〈0.05）。ICE组患者术后1周CD3^＋、CD4^＋、CD4^＋／CD8^＋略有增高，至1个月后显著高于术前（P〈0.05）。原发性肝癌患者术前VEGF较高，而术后1个月较前降低。TACE术后1周VEGF降低，而1个月后再次增高（P〈0.05）。ICE组患者术后1周VEGF降低，至1个月后显著低于TACE组（P〈0.05）。TACE组1年生存率高于单纯手术组（P〈0.05），2年、3年生存率较单纯手术组无统计学意义（P〉0.05）。ICE组1、2、3年生存率均高于单纯手术组（P〈0.05）。结论ICE可有效预防肝癌术后复发，提高1、2、3年的生存率。
Objective To make clear of the mechanism of metastasis and recurrence of primary liver cancer, and to make sure of the preventive value of transcatheter arterial immun-chemoembolization （ICE） in treatment of liver cancer. Methods The study is a double- blinded, controlled, prospective, randomized trial. 146 patients were randomly divided into 3 groups. Group A： regular surgery of primary liver cancer; group B： TACE 1 month after surgery, treatment proposal was： ADM ＋ DDP ＋ 5-Fu ＋ LP; group C：transcatheter arterial immun-chemoembolization 1 month after surgery, treatment proposal ： ADM ＋ DDP ＋5-Fu ＋ LP ＋ Octreotide ＋ IFN. Results CD3^＋、CD4^＋、CD4^＋/CD8^＋ increased 1 month after surgery in group A ; In group B ：CD3^＋、CD4^＋、CD4^＋/CD8^＋ decreased but CD8^＋ increased 1 week after TACE ;CD3^＋、CD4^＋、CD4^＋/CD8^＋ increased but CD8^＋ decreased 4 weeks after TACE（P〈0.05） ; In group C ：CD3^＋、CD4^＋、CD4^＋/CD8^＋ increased slightly 1 week after TACE, but increased significantly 4 weeks later（P 〈0. 05）. In group A, the level of VEGF was high before surgery but decreased 1 month after surgery; In group B, the level of VEGF decreased 1 week after TACE, decreased more significantly 4 weeks after TACE than that in group B（ P 〈 0. 05 ）. 1 year survival rate, 2 year survival rate and 3 year survival rate in group C ware higher than those in group A; 1 year survival rate was higher in group B than that in group A, however, 2 year survival had and 3 year survival rate had no differences between group B and group A. Conclusion Transcatheter arterial ICE can prevent metastasis and recur- rence after surgery of primary liver cancer increase the 1,2,3 year survival rate. It not only has the role of TA-CE, but can increase the immunefunction, and inhibit tumor angiogenesis, then increase the therapeutic effect.
出处
《国际肿瘤学杂志》
CAS
2009年第6期477-479,共3页
Journal of International Oncology
基金
山东省医药卫生科技发展计划项目（2003年有资161号）.
关键词
化学栓塞
治疗性
肝肿瘤
肝动脉
免疫疗法
奥曲肽
Chemoembolization, theraputic
Liver neoplasms
Hepatic artery
Immunotherapy
Octreotide
