免疫化疗栓塞技术预防原发性肝癌术后复发的意义

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+、CIM+、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+、CIM+/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.

Significance of preventive transcatheter arterial immue-chemoembolization in primary liver cancer after operation

Objective To make clear of the mechanism of metastasis and recurrence of primary liver cancer, and to make sure of the preventive value of transeatheter arterial immun- ehemoembolization (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 1month after surgery, treatment proposal was: ADM + DDP + 5-Fu + LP; group C:transeatheter 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 differ-ences between group B and group A. Conclusion Transcatheter arterial ICE can prevent metastasis and recurrence after surgery of primary liver cancer increase the 1,2,3 year survival rate. It not only has the role of TACE,but can increase the immunefunction,and inhibit tumor angiogenesis, then increase the therapeutic effect.