摘要
目的晚期肾癌患者生存率较低,对放化疗敏感性不高,本课题组回顾性分析自体DC-CIK细胞治疗肾透明细胞癌术后患者72例的临床疗效和安全性,分析淋巴细胞亚群与血清胆固醇的相关性。方法采集2011-08-12-2016-04-28解放军第八一医院肿瘤生物治疗科72例肾癌患者的外周血单个核细胞(peripheral blood mononuclear cell,PBMC),经实验室体外诱导培养成树突细胞(dendritic cell,DC)和细胞因子诱导的杀伤(cytokine induced killer,CIK)细胞,DC通过肾癌786-0细胞裂解物负载后与CIK分别回输到患者体内,观察DC-CIK细胞治疗肾癌患者的临床疗效和安全性,分析治疗前后淋巴细胞亚群及血脂水平的相关性。结果72例肾癌患者经DC-CIK细胞免疫治疗后,数据不全及失访30例,剩余42例客观缓解率为33.33%,疾病控制率为73.81%;1年生存率为83%,2年生存率为55%,3年生存率为40%。与治疗前相比,甘油三酯水平升高[(1.58±0.74)mmol/L vs(2.46±1.94)mmol/L,t=-3.216,P=0.003],末次治疗后患者外周血CD3^+CD8^+细胞比例升高[(22.88±6.76)% vs(25.60±8.69)%,t=-2.760,P=0.009],CD4^+CD25^+细胞、CD3^+CD4^+细胞和CD4^+CD8^+比例下降,分别为[(3.51±1.23)% vs(3.05±1.27)%,t=2.318,P=0.026]、[(36.00±11.34)% vs(32.80±10.88)%,t=2.828,P=0.028]、[(1.76±0.88) vs(1.46±0.72),t=3.086,P=0.04]。Pearson相关性分析显示,晚期肾癌患者血清甘油三酯与B细胞比例呈正相关,r=0.387,P=0.011,高密度胆固醇与NK细胞比例呈正相关(r=0.362,P=0.018),高密度胆固醇与调节性T细胞比例呈负相关(r=-0.303,P=-0.049)。单因素分析显示,TNM分期、细胞治疗周期、治疗前KPS评分为DC-CIK治疗肾癌的预后影响因素,均P<0.05);多因素分析显示,年龄、TNM分期、KPS评分是独立预后影响因素。结论DC-CIK细胞免疫治疗对于肾癌患者是一种安全有效的治疗方式,多次治疗可能提高患者远期生存率,血清胆固醇代谢水平可能参与肿瘤的免疫。
OBJECTIVE Due to the low survival rate of patients with advanced renal cell carcinoma and low sensitivity to radiotherapy and chemotherapy,our group has retrospectively analyzed the clinical efficacy and safety of 72 cases of renal clear cell carcinoma combined with autologous DC-CIK cells therapy after surgery and to investigate the correlation between lymphocyte subsets and serum cholesterol.METHODS Peripheral blood mononuclear cells were collected from 72 patients with renal cell carcinoma who participated in the clinical study from the Tumor Biology Treatment Department of PLA NO.81 Hospital of from August 12,2011 to April 28,2016.These cells were induced and cultured into dendritic cells(DC)and cytokine-induced killer(CIK)cells in vitro.DCs were sensitized by lysate of renal cancer 786-0 cells and then infused into CIK cells.The clinical efficacy and safety of DC-CIK cells in treatment of renal cell carcinoma were observed.The correlation between lymphocyte subsets and serum lipid levels before and after treatment was analyzed.RESULTS After immunotherapy with DC-CIK cells in 72 patients with renal cell carcinoma,30 cases were incomplete and lost follow-up.The objective remission rate of the remaining 42 cases was 33.33%,and the disease control rate was 73.81%.The 1-year survival rate was 83%,the 2-year survival rate was 55%,and the 3-year survival rate was 40%.Triglyceride levels were elevated[(1.58±0.74)mmol/L vs(2.46±1.94)mmol/L,t=-3.216,P=0.003)]compared with those before treatment.After treatment,the proportion of CD3+CD8+cells in peripheral blood was significantly increased[(22.88±6.76)% vs(25.60±8.69)%,t=-2.760,P=0.009],the percentage of CD4+CD25+cells,CD3+CD4+cells and CD4+CD8+cells were significantly lower than those in control group[(3.51±1.23)% vs(3.05±1.27)%,t=2.318,P=0.026],[(36.00±11.34)% vs(32.80±10.88)%,t=2.828,P=0.028],[(1.76±0.88)vs(1.46±0.72),t=3.086,P=0.04].Pearson correlation analysis showed that there was a positive correlation between serum triglyceride and B cell ratio(r=0.38
作者
孔丹丹
江龙委
郑劼
张启婷
张燕
艾月琴
张闯
赵华
高艳荣
李文明
胡建华
贾绍昌
KONG Dan-dan;JIANG Long-wei;ZHENG Jie;ZHANG Qi-ting;ZHANG Yan;AI Yue-qin;ZHANG Chuang;ZHAO Hua;GAO Yan-rong;LI Wen-ruing;HU Jian-hua;JIA Shao-chang(PLA NO.81Clinical Academy of Anhui Medical University ,Nanjing210002,P.R.China;Department of Oncology Biotherapy,81st Hospital of PLA,Nanjing,Jiangsu 210002;Central Laboratory of the 81st Hospital of the Chinese People's Liberation Army,Nanjing,Jiangsu 210002)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2018年第21期1515-1521,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
南京军区医药卫生科研基金面上项目(14MS052)
