国际肿瘤学杂志
國際腫瘤學雜誌
국제종류학잡지
JOURNAL OF INTERNATIONAL ONCOLOGY
2009年
6期
477-479
,共3页
孙萍%张良明%孙等军%耿冬梅
孫萍%張良明%孫等軍%耿鼕梅
손평%장량명%손등군%경동매
化学栓塞%治疗性%肝肿瘤%肝动脉%免疫疗法%奥曲肽
化學栓塞%治療性%肝腫瘤%肝動脈%免疫療法%奧麯肽
화학전새%치료성%간종류%간동맥%면역요법%오곡태
Chemoembolization,theraputic%Liver neoplasms%Hepatic artery%Immunotherapy%Octreotide
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.
目的 探討免疫化療栓塞術(ICE)預防肝癌術後複髮轉移的機製,確定ICE的預防價值.方法 選擇146例可手術的原髮性肝癌患者,隨機分為:A組單純手術,B組術後肝動脈化療栓塞術(TACE),C組術後ICE.A組常規方法行肝癌切除術,術後予對癥支持治療;B組術後1箇月行TACE,方案為阿黴素+順鉑+5氟尿嘧啶+碘化油;C組方案改為阿黴素+順鉑+5氟尿嘧啶+碘化油+奧麯肽+榦擾素,餘同B組.分彆測定外週血T細胞亞群,A組患者入院後第2天、術後1週、1箇月;B組患者TACE術前、術後1週、1箇月;C組患者免疫化療栓塞術前、術後1週、1箇月.酶聯免疫吸附測定法測定所有患者術前、術後1天、術後1箇月,介入治療術後第1、3、7、14天及1箇月的外週血血管內皮生長因子(VEGF)值.統計各組1、2、3年的複髮率及生存率.結果 原髮性肝癌患者術前CD3+、CIM+、CD4+/CD8+均較低,而術後1箇月各項指標升高.TACE術後1週CD3+、CD4+、CD4+/CD8+均降低,CD8+升高;而1箇月後CD3+、CD4+、CD4+/CD8+均升高,CD8+降低(P<0.05).ICE組患者術後1週CD3+、CD4+、CIM+/CD8+略有增高,至1箇月後顯著高于術前(P<0.05).原髮性肝癌患者術前VEGF較高,而術後1箇月較前降低.TACE術後1週VEGF降低,而1箇月後再次增高(P<0.05).ICE組患者術後1週VEGF降低,至1箇月後顯著低于TACE組(P<0.05).TACE組1年生存率高于單純手術組(P<0.05),2年、3年生存率較單純手術組無統計學意義(P>0.05).ICE組1、2、3年生存率均高于單純手術組(P<0.05).結論 ICE可有效預防肝癌術後複髮,提高1、2、3年的生存率.
목적 탐토면역화료전새술(ICE)예방간암술후복발전이적궤제,학정ICE적예방개치.방법 선택146례가수술적원발성간암환자,수궤분위:A조단순수술,B조술후간동맥화료전새술(TACE),C조술후ICE.A조상규방법행간암절제술,술후여대증지지치료;B조술후1개월행TACE,방안위아매소+순박+5불뇨밀정+전화유;C조방안개위아매소+순박+5불뇨밀정+전화유+오곡태+간우소,여동B조.분별측정외주혈T세포아군,A조환자입원후제2천、술후1주、1개월;B조환자TACE술전、술후1주、1개월;C조환자면역화료전새술전、술후1주、1개월.매련면역흡부측정법측정소유환자술전、술후1천、술후1개월,개입치료술후제1、3、7、14천급1개월적외주혈혈관내피생장인자(VEGF)치.통계각조1、2、3년적복발솔급생존솔.결과 원발성간암환자술전CD3+、CIM+、CD4+/CD8+균교저,이술후1개월각항지표승고.TACE술후1주CD3+、CD4+、CD4+/CD8+균강저,CD8+승고;이1개월후CD3+、CD4+、CD4+/CD8+균승고,CD8+강저(P<0.05).ICE조환자술후1주CD3+、CD4+、CIM+/CD8+략유증고,지1개월후현저고우술전(P<0.05).원발성간암환자술전VEGF교고,이술후1개월교전강저.TACE술후1주VEGF강저,이1개월후재차증고(P<0.05).ICE조환자술후1주VEGF강저,지1개월후현저저우TACE조(P<0.05).TACE조1년생존솔고우단순수술조(P<0.05),2년、3년생존솔교단순수술조무통계학의의(P>0.05).ICE조1、2、3년생존솔균고우단순수술조(P<0.05).결론 ICE가유효예방간암술후복발,제고1、2、3년적생존솔.
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.
