杀伤细胞和树突状细胞联合治疗晚期直肠癌的临床观察

目的评估细胞因子诱导的杀伤细胞(CIK)和树突状细胞(DC)联合治疗晚期直肠癌的临床疗效。方法将2007年8月至2009年8月收治的89例Ⅳ期直肠癌患者随机分为单纯化疗组和联合治疗组,其中单纯化疗组48例,采用FOLFOX4方案,化疗6¹2个疗程;联合治疗组41例,除采取相同的化疗方案外,同时诱导培养患者自身CIK和DC细胞,CIK细胞静脉回输,DC细胞给予患者腹股沟、腋下淋巴结注射和淋巴结附近皮下注射,观察两组患者治疗前后瘤体变化、癌胚抗原(CEA)变化、细胞免疫指标改变(CD+3、CD+4、CD+8、CD+4/CD+8、CD+3CD+56、CD-3CD+56)和Karnofsky评分,同时记录生存期。结果单纯化疗组无完全缓解(CR)病例,部分缓解(PR)5例,好转(MR)20例,化疗后总有效率为52.1%(25/48)。联合治疗组CR 1例,PR 8例,MR 19例,总有效率为68.3%(28/41),高于单纯化疗组(P<0.05)。联合治疗组治疗后CD+3、CD+4、CD+4/CD+8、CD+3CD+56、CD-3CD+56比较显著高于治疗前,而CD+8则低于治疗前。联合治疗组治疗后Karnofsky评分明显提高(平均提高13分,P<0.05)。单纯化疗组的2年生存率为54.2%(26/48),联合治疗组的2年生存率为70.7%(29/41),差异有统计学意义(P<0.05)。结论 CIK细胞和DC细胞联合化疗可有效提高晚期直肠癌疗效,增强患者自身免疫功能,改善患者生存质量,是无手术指征的晚期直肠癌患者安全、有效的治疗方法。

Clinical observation of Co-treatment with CIK cells and dendritic cells for advanced rectal cancer

Objective To evaluate the clinical effects of cytoukine-induced killer （CIK）cells in combination with dendritic cells（DC） on advanced rectal cancer. Methods 89 cases with advanced rectal cancer（ stage IV ）treated in our hospital from August 2007 to August 2009 were divided randomly into two groups： （1） Chemotherapy group consisted of 48 cases, obtained 6 to 12 cycles of chemotherapy with the protocol of FOLFOX4 ; （ 2 ） Therapeutic alliance group consisted of 48 cases, besides the same chemothera- peutical protocol,were transfused of autologous CIK cells and were injected with DC into inguinal lymph nodes, axillary lymph nodes and near site. We detected the changes of tumor burden, eareinoembryonie anti- gen（CEA）, cellular immune responses （ CD3^＋, CD4^＋, CD8^＋, CD4^＋/CD8^＋, CD3^＋ CD56^＋, CD3^-CD56^＋ ）, the Kainofsky＇s grade and 2-year cumulative survival rate. Results The effective rate of the chemotherapy group consisted of 5 partial remission（PR） and 20 minor remission（MR） was 52. 1%, and the effective rate of the therapeutic alliance group consisted of 1 complete remission （CR）, 8 partial remission （PR）and 19 minor remission（MR）was 68. 3%. The proportions of CD3^＋,CD4^＋ ,CD3^＋ CD56^＋ ,CD3^-CD56^＋ and the ratio of CD4^＋/CD8^＋ were significantly increased in the therapeutic alliance group, but the proportions of CD8^＋ was de- ceased. Karnofsky＇s grade was also increased in the therapeutic alliance group. The 2-year cumulative sur- vival rate in the chemotherapy group and the therapeutic alliance group were 54. 2% and 70. 7%, respectively. There was significant difference between two groups （P 〈 0. 05）. Conclusion Co-treatment with CIK cells and dendritic ceils, which could increase clinical effects, immunity and improve life quality, was effec- tive and safe to sdvanced rectal cancer.