冷冻消融免疫效应的研究进展

冷冻消融术是一种肿瘤微创治疗,具有局部消瘤作用确切、不良反应小、安全性高等优势,并能激发体液免疫和细胞免疫,甚至诱导远处病灶消失即远位效应,因此具有局部和全身双重治疗效应。然而,冷冻消融引起的免疫效应可能出现免疫增强、免疫无应答或免疫抑制,这与癌症类型、坏死/凋亡比例、冷冻范围、冷冻速率、冷冻数量等密切相关。冷冻消融可增大坏死/凋亡比例,联合细胞过继疗法、粒细胞-巨噬细胞集落刺激因子、免疫检查点抑制剂、Toll样受体激动剂能够增强全身性免疫效应。然而,如何利用、加强冷冻消融的远位效应仍然是治疗肿瘤,尤其是晚期肿瘤的关键。     

冷冻治疗对直肠癌病人免疫功能的调节

用OKT系列和Ia单克隆抗体和免疫荧光技未测定11例不能手术的晚期直肠癌病人周围血OKT_3,OKT_4,OKT_8和Ia阳性细胞白分率并与16例正常人作对照,比较冷冻治疗前后T细胞亚群Ia阻性细胞和血清免疫球蛋白的改变。冷冻术前患者周围血OKT_3和OKT_4阳性细胞明显减少(p<0.01);但OKT_8阳性细胞增加(P<0.01);OKT_4/OKT_8比值明显减少(P0.01)。这些结果提示晚期直肠癌病人免疫平衡明显失调,OKT_8阳性细胞增加可能与肿瘤分泌的肿瘤抗原特异牲抑制因子有关。冷冻治疗后,OKT_4和Ia阳性细胞明显增加,OKT_4/OKT_8比值虽没有恢复正常,与冷冻前比较,有所增加。提示冷冻治疗对宿主免疫平衡的调节起一定作甩。血清IgA ,IgM,IgG在冷冻治疗前后无显著差异,但与正常人比较:显著增加,其意义还不清楚。     

射频热消融治疗中晚期胰腺癌

射频热消融因在治疗肝脏肿瘤方面取得了明显的效果而引起了人们广泛的关注。不少学者开始将其应用于肺癌、肾癌治疗，取得了较好效果。对于中晚期胰腺癌患者目前尚无有效治疗方法，能否将射频热消融用来治疗胰腺癌引起了人们的兴趣。2000年10月-2003年7月，我们采用射频热固化治疗局部进展期胰腺癌患者8例，取得一定效果。     

免疫检查点抑制剂的联合治疗在胰腺癌中的研究进展

胰腺癌的恶性程度极高,发现时通常已至晚期,中位生存时间极短,严重威胁人类生命健康.并且与其他癌种相比,近些年取得的治疗进展也十分有限.免疫检查点抑制剂(Immune checkpoint inhibitors,ICIs)作为近几年的新兴药物已在多个肿瘤中获得了令人振奋的治疗效果,但是在胰腺癌中却遭遇了滑铁卢.胰腺癌对I...     

冷冻消融治疗对胰腺癌患者细胞免疫功能影响的观察

目的:探讨胰腺癌患者冷冻消融治疗前后外周血T细胞亚群和NK细胞及TNF-α水平的变化及临床意义.方法:采用流式细胞术和ELISA法分别测定37例胰腺癌患者冷冻前后外周血T细胞亚群CD3、CD4、CD8和NK细胞及TNF-α有水平,并与健康对照组比较.结果:与对照组相比,患者术前的CD3、CD4、CD4/CD8及NK水平...     

胰腺癌的综合治疗

介绍有关胰腺癌的多种治疗方法，其中不仅包括外科手术，放疗，化疗等传统治疗，而且含盖了新近开展的免疫及基因治疗。指出了胰腺癌治疗综合化的趋势。     

肺癌冷冻术后早期机体免疫功能的变化

对冷冻手术治疗的１０例肺癌患者使用单抗致敏红细胞花环法及单向免疫琼脂扩散法分别检测手术前、后不同时期的外周血Ｔ淋巴细胞亚群及血清免疫球蛋白的改变。结果表明：冷冻术后的、比值均较术前显著增加（Ｐ＜０．０１），而ＯＫＴ８则显著减少（Ｐ＜０．０１）。免疫球蛋白也显著增加（Ｐ＜０．０１）。提示：冷冻术能恢复肺癌病人的免疫平衡。冷冻术尚可激发人体的抗肿瘤免疫，即存在冷冻免疫效应。     

射频消融治疗不可切除胰腺癌研究进展

胰腺癌恶性程度高,进展迅速,是消化系统常见的恶性肿瘤,相对于其他实体肿瘤的治疗,胰腺癌治疗效果令人失望,5年总生存率低于5％。手术切除是唯一可能治愈胰腺癌的手段。Cameron等回顾性分析了405例胰头癌胰十二指肠切除术,术后5年的生存率可达18％。但胰腺癌起病隐匿,早期发现困难,易发生转移,明确诊断的胰腺癌病人可行根治性手术者仅占10％-20％,大部分患者因远处转移或血管浸润而无法手术切除。目前,对晚期不可切除胰腺癌病人主要采用放疗、     

氩氦刀冷冻消融术与抗肿瘤免疫效应

氩氦刀冷冻消融术作为一种肿瘤物理消融治疗方式,具有微创、安全、有效等特点.研究表明其效果不仅在于直接杀伤肿瘤细胞,而且机体抗肿瘤免疫状态的激活对抑制局部肿瘤生长及消除残余肿瘤细胞也起着重要作用.     

Neoadjuvant Treatment for Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with limited effective therapeutic options and exceedingly high mortality rates. Currently, cure can only be achieved through resection, however the vast majority of patients present with advanced disease for which upfront surgery is not an option. In an effort to improve surgical candidacy, neoadjuvant chemotherapy, with or without radiation therapy, is often used in an effort to downstage borderline resectable and locally advanced tumors, and some argue for its use even in patients with resectable tumors. Underlying this thinking is the recognition that pancreatic cancer is simultaneously both a locally invasive and systemic disease, even in patients without evidence of metastasis on imaging. Current evidence to date is largely retrospective, but suggests that neoadjuvant therapy can increase R0 (pathologically negative margin) resection rates and improve overall survival. The standard approach to neoadjuvant treatment involves choosing between the two most active combination regimens for metastatic disease, namely modified FOLFIRNOX and gemcitabine/nab-paclitaxel. Nonrandomized data indicate that these regimens can yield resection rates up to 68% and 36%, in borderline resectable and locally advanced PDAC, respectively. Furthermore, randomized data in patients with resectable PDAC treated with gemcitabine-based neoadjuvant therapy suggests that despite an approximate 10% drop in resection rates, there is a significant improvement in median overall survival. Herein, we will discuss the rationale for neoadjuvant therapy, current and former treatment regimens, common issues faced by clinicians when using these combinations, and several ongoing clinical trials.     

Latitude and Pancreatic Cancer

With regard to the geographical distribution of pancreatic cancermortality, the relationship of the latitude and of the averagetemperature to pancreatic cancer mortality was examined. Bothinternationally and within Japan, a strong positive associationbetween latitude and pancreatic cancer mortality and a strongnegative association with the average temperature were observed.The simple correlation coefficient between pancreatic cancermortality and the latitude was 0.724 for males and 0.725 forfemales, and that between pancreatic cancer mortality and theaverage temperature was –0.773 for males and –0.729for females in 26 countries. In the 47 prefectures in Japan,the coefficient was 0.612, 0.615, –0.589, and –0.630respectively. Most of these relationships remained statisticallysignificant after controlling for per capita consumption offood which was also related to the pancreatic cancer mortalityinternationally, such as sugar, eggs, milk and dairy products,oils and fats, pulse, coffee, and fat. Within Japan, an urban-ruraleffect on the pancreatic cancer mortality was not observed inspite of a higher intake of fat in large cities. There remainsthe possibility that factors related to latitude or averagetemperature other than diet may be involved in the occurrenceof pancreatic cancer.     

老年患者的大胰癌外科治疗

目的 探讨老年患者胰腺癌接受胰十二指肠切除术,以期明确手术成功的相关因素。方法 本研究包括74例大胰癌患者。35例年龄大于70岁,30例为标准胰十二指肠切除术和5例为区域性胰十二指肠切除术,其中15例按“三步法”予以切除。这组患者的结果与另外39例非老年患者作比较。结果 老年患者的30天手术死亡率与并发症率分别为5.9％和26.4％;而在非老年患者中分别为5.2％和18.4％。危险因素、并发症率和死亡率差别有统计学意义。老年患者和非老年患者的5年生存率分别为11.7％和15.7％,无显著性差异。结论 本研究表明老年患者可安全接受根治性胰十二指肠切除术,而长期效果与非老年患者相似。减黄可改善肝、肾功能,增加患者对手术的耐受。术前介入化疗可在肿瘤与门静脉间产生“炎性水帘”,从而减少门静脉切除率。     

胰腺癌的分子靶向治疗

胰腺癌是恶性程度最高的肿瘤之一,它具有早期侵袭性生长和远处转移的特性,预后极差,据统计,只有15％病例可进行手术治疗,5年生存率不足3％,抗肿瘤治疗如放疗、化疗、免疫治疗不敏感是导致其预后恶劣的原因之一。肿瘤的发生、发展以及对抗肿瘤治疗效果欠佳,主要是因为肿瘤细胞对诱导凋亡的刺激缺乏反应。随着肿瘤靶向治疗的进展,与胰腺癌发生、发展、侵袭、转移有关的分子标志的逐步阐明,针对特异性分子靶向目标的治疗性药物相继产生,为改善胰腺癌治疗的效果提供了新的机会。