进展期胃癌术后树突状细胞疫苗同步化学治疗的免疫功能监测

目的 评价进展期胃癌术后树突状细胞(DC)免疫治疗同步化学治疗的临床疗效及治疗后免疫功能的变化.方法 将64例进展期胃癌患者分为两组,对照组为单纯化学治疗组(38例),采用LCH方案,给予5-氟尿嘧啶0.75 g/d_(1～5),奥沙利铂0.2 g/d_1;DC疫苗同步化学治疗组(DC治疗组)26例,自体采血,次日开始LCH方案治疗,化学治疗结束后1周注射DC疫苗2次,每次间隔1周,28 d后进行第2次化学治疗,同样再次注射DC疫苗2次为1个疗程.比较两组治疗前、后T淋巴细胞亚群及自然杀伤(NK)细胞百分率变化、细胞因子含量变化及疗效.结果 DC治疗组患者治疗后,CD3~+、CD4~+、NK细胞、白细胞介素(IL)-2、IL-12和干扰素(IFN)-γ均较治疗前明显上升,且高于对照组化疗后(P＜0.05),DC治疗组治疗有效率(无远处转移、腹腔或锁骨上淋巴结不肿大或肿瘤明显缩小)为80.76%,较对照组(68.42%)明显升高(P＜0.05).DC治疗组外周血白细胞和免疫细胞下降等化学治疗的不良反应明显较少(P＜0.05),而胃肠道反应和末稍神经炎的发生率两组问差异无统计学意义(P＞0.05).结论 采用DC疫苗同步化学治疗法治疗进展期胃癌的近期疗效较好,且能减少化学治疗的不良反应.

Immune surveillance on postoperative patients with advanced gastric cancer treated with concurrent chemotherapy and dendritic cells vaccine

Objective To evaluate clinical outcome in postoperative patients with advanced gastric cancer treated with concurrent chemotherapy and dendritic cells (DCs) vaccine as well as alteration of immune function. Methods Sixty-four postoperative patients with advance gastric cancer were divided into control group and DC vaccine group, In control group, 38 patients were treated with LCH regimen consisted of 5-fluorouracil 0.75 g/d_(1-5) and oxaliplatin 0.2 g/d_1. In DC vaccine group,blood sample was obtained from 26 patients who were followed by LCH regimen treatment next day.One week after the chemotherapy, patients were immunized with DC vaccine for 2 times at interval of one week. The second cycle was performed after 28 days. The percentages of T lymphocytes and natural killer (NK) cells and cytokine levels before and after treatment were compared between two groups. The therapeutic effects (including no remote metastasis and enlarged lymph nodes in cavity and/or tumor reduced in volume) were also evaluated. Results The concentrations of T lymphocytes (CD3~+ and CD4~+ ), NK cells, interleukin (IL)-2, IL-12 and interferon-γ in DC vaccine group were significantly increased after vaccination compared with those before vaccination (P＜0.05), and even higher than those in control group (P＜0.05). The effective rate was higher in DC vaccine group (80. 76%) than that in control group (68.42%) with significant difference (P＜0. 05). The side effects of chemotherapy such as the decreased peripheral white blood ceils and immune cells were less serious in DC vaccine group compared with control group (P＜ 0.05), while the uncomfortable incidence of gastrointestinal tract and peripheral neuritis showed no significant difference between two groups (P＞0.05). Conclusions Application of concurrent chemotherapy and DC vaccine in patients with advanced gastric cancer after surgical treatment may achieve a short-term efficacy, meanwhile it can reduce the side effects induced by chemotherapy.