【作者】 赵明； 吴沛宏； 曾益新； 夏建川； 张福君； 洗丽坚； 张毓平； 周琨； 范卫君； 高飞； 周启明；

【Author】 Zhao Ming Wu Pei-Hong Zeng Yi-Xin Xia Jian-Chuan Zhang Fu-Jun Xian li-Jian Zhang Yu-Ping Zhou Kun Huang Jing-Hua Fan Wei-Jun Gao Fei ZhouQi-Ming Department of Imaging and Interventional Radiology, Cancer hospital, Department of Cancer Institute, Cancer hospital, Sun Yat- sen University, Guangzhou Guangdong 510060,China

【机构】 中山大学肿瘤医院影像介入中心； 中山大学肿瘤医院肿瘤研究所； 河北医科大学第一附属医院； 河北工程学院临床医学院；

【摘要】 目的:随机对照研究一组TACE(transcatheter arterial chemoeblization)序贯联合CT导向下RFA (radiofrequency ablation)与TA CE序贯联合CT导向下 RFA及CIK(cytokine induced killer cells)细胞经肝动脉灌注治疗原发性肝癌(pfimary hepatoceHular carcinoma, HHC)的病例,并评价两种方法在HCC治疗中的疗效和抗病毒作用。方法:57例HCC经TACE序贯联合RFA治疗后 6—8周,经临床评价无明确残留病变,进行随机化分组。联合 CIK治疗组31例患者,首先连续完成4次CIK细胞经肝动脉回输,每次间隔时间为1-3周;再每4周1次,共行4次CIK 细胞经肝动脉回输,每次回输CIK的数量为1．1×1010-1．5 ×1010。患者随访1年以上并每1-2月评价肿瘤情况。TACE 联合RFA治疗组26例患者出院每1-2月评价肿瘤情况,随访1年以上。结果:2组病例1年生存期均达到100%。联合 CIK组共31例,6个月内复发1例;1年内共3例复发,2例出现肝内复发,1例出现肝门区淋巴结转移,28例为无瘤生存 (90．32％)。TACE联合RFA治疗组26例中6月内2例复发, 1年内共有6例复发,其中5例为肝内复发,1例出现肺转移, 20例为无瘤生存(76．92％)。6个月随访无瘤生存率,两组无显著差异,但是对于1年无瘤生存率有两组存在统计学差异 (P<0．05)。联合CIK组,治疗前HBV-DNA含量小于1． 0×103者为19例,治疗后上升到27例,其中有2例乙肝表面抗原转阴。治疗前HBV—DNA含量在1．0 × 10-3-1．0× 106之间者为11例,治疗后为4例,治疗前HBV—DNA含量在1．0×106以上者1例,治疗后为1．6×104。而TACE联合RFA治疗组仅1例血HBV—DNA含量由治疗前的1．1× 105下降1．0×103以下。HBV—DNA含量在治疗前后两组存在统计学差异(P<0．01)。结论:TACE序贯联合RFA治疗和抗肿瘤效应细胞(CIK)是治疗原发性肝癌一种新的模式,它提高了原发性肝癌无瘤生存期并明显降低乙肝病毒体内含量或活消除乙肝病毒,阻断致癌因素。更多还原

【Abstract】 Objective: A prospective study to evaluate the clinic effect of autologous cytokine-induced killer cells (CIK) in reduce the relapse of the patients with primary hepatocellular carcinoma (HCC) and the effect of anti-HBV after the treatment of transcatheter arterial chemoeblization ( TACE ) sequentially combined with CT-guided radiofrequency ablation (RFA). Methods: 57 cases of HCC received treatment of TACE and CT-guided RFA, without residue tumor or extrahepatic metastasis evaluated by AFP content, contrast CT, positron emission tomography-CT (PET-CT), digital substraction angiog-raphy (DSA) or fine needle biopsy. They were randomly divided into 2 groups after received TACE and CT-guided RFA, one group (31 cases) received autologous CIK cells infusion by common hepatic artery every 1-3 weeks for four times, then every 4 weeks for 4 times, the number of CIK cells infused ranged from 1.1 × 1010-1.5 × 1010 every time. The control group (26 cases) only received TACE combined with RFA was discharged for follow-up. Results: In study group, 28/31 (87.10% )cases were recurrence ree in one year follow-up, 1/31 had recurrence in liver within 6 months, 1/31 had recurrence in liver and 1/31 case had lymphoadenopathy in hepatic hi-lum within one year. In control group, 20/26 (76.92%) cases were recurrence ree, 2/26 cases had recurrence in liver within 6 months, 2/26 cases had recurrence in liver and 1/26 had lung metastasis for one year follow-up. In study group, There were 19 cases that HBV-DNA content was below 1 × 103 before treatment and it became. 27 cases after treatment and of those 2 cases of HBs-Ag positive turned to negative, there droped from 11 to 4 cases in HBV-DNA content between 103- 106, the HBV-DNA content of 1 case droped from 1.6 × 107 to 1.6 × 104 after treatment In control group, HBV-DNA content of only one case the HBV-DNA content dropped from 1.1 × 105 to below 103. Conclusion: Autologous CIK cells were efficient effector cells against microscopic lesions and had the effect of anti-virus .So it could reduce the frequency of recurrence or prolonged the recurrence ree span after TACE sequentially combined with CT-guided RFA procedure. Our results indicated that this methods probably provided a new therapeutic strategy for HCC.更多还原