开腹射频消融术对多发性大肝癌患者免疫功能与生存时间的影响

目的 探讨开腹射频综合治疗对多发性大肝癌患者生存期的影响及机理.方法 回顾性分析2003年1月至2007年1月在我院治疗的多发性大肝癌45例患者的治疗方法.单纯肝动脉栓塞化疗(TACE组)20例,手术多发灶局部切除+TACE治疗(局部切除组)13例,开腹射频消融治疗+TACE(开腹射频组)12例.分析各组患者治疗前后T淋巴细胞亚群水平的变化,并比较各组的完全缓解率及生存率.结果 治疗后4周射频组患者CD4+、NK细胞水平、CD4+/CD8+比值比治疗前明显升高(P<0.05),而手术局部切除组及TACE组无明显变化,局部切除组术后短期内还出现了免疫抑制现象.开腹射频组、局部切除组与TACE组的完全缓解率分别为41.70%,46.20%,25.50%,3组比较差异无统计学意义(x2=1.81,P>0.05).3组的1.5年与2年的生存率分别为75.00%、69.20%、30%(x2=7.96,P<0.05),以及50.00%、23.10%、10.00%(x2=18.98,P<0.05).3组的平均生存期分别为26.56个月、21.04个月、16.41个月(x2=14.69,P<0.001).开腹射频组的总生存率明显高于其他组(x2=4.635,P<0.05).开腹射频组与局部切除组比较,开腹射频组患者带瘤生存时间延长(x2=4.615,P<0.05).结论 以开腹射频为主的综合治疗通过提高肝癌患者的细胞免疫功能明显延长患者生存时间.

Radio-frequency ablation for multiple hepatic cancer

Objective To study the effects of intraoporative radio-frequency ablation on immune functions and survival of patients with multiple large hepatic cancer. Methods Forty five admitted patients with multiple large hepatic cancer from January 2003 to January 2007 were devided into: simple hepatic artery embohzation chemotherapy group (TACE group, n = 20) , local resection of multiple lesion + TACE (LR group, n = 13), and TACE + intraoperative radio-frequency ablation (IRFA group, n = 12). The changes of peripheral blood T-cell subsets were evaluated using flow cytometry, and a comparison of the complete remission rate and survival rate between the 3 groups was made and the survival rate analyzed with Kaplan-Meier method, the validity check with long-rank method. Results CD4+ , NK, and CD4+/ CD8+radio significantly increased 4 weeks after treatment only in IRFA group. The immune function was suppressed during the first week after treatment in local resection group. Tumor complete remission rate in IRFA group, local resection group and simple TACE group were 41.70%, 46. 20% and 25.50% respectively, the difference was not statistically significant between the 3 groups (x2 = 1.81, P > 0.05). the 1.5 year and 2.0 year survival rate in the 3 groups were 75.00%, 69. 20%, 30% (x2 = 7.96, P < 0.05) and 50.00%, 23.10%, 10. 00% respectively (x2 = 18.98 ,P <0.05), the mean survival period of patients in the 3 groups was 26. 56 months, 21.04 months, and 16.41 months respectively (x2 = 14.69, P < 0.001). Kaplan-Meier survival curve showed the overall survival rate in the IRFA group was significantly higher than that of the other 2 groups (x2 = 4.635, P < 0.05). The prolongation of the survival period in patient with multiple macronodular hepatic cancer after IRFA treatment was mainly due to the prolongation of survival period in tumor bearing patients (IRFA group vs LR group, x2= 4.615, P < 0.05). Conclusion IRFA prolongs the survival of patients with multiple macranodular hepatic cancer possibly by enhancing the functions of cellular immunity.