【作者】 曾江正； 刘光清； 郝新宝； 洪涛； 张建辉； 苏群豪； 黄美珠； 雷俊华；

【机构】 海南医学院附属医院肿瘤研究所肿瘤内科； 海南医学院附属医院超声科；

【摘要】 目的探讨冷循环射频消融治疗对原发性肝癌(HCC)患者调节性T细胞(Treg)变化及其对预后的影响。方法流式细胞仪检测冷循环射频消融治疗前、治疗后1月、4月、7月、12月后外周血调节性T细胞变化。随访期间采用超声造影或肝脏增强CT评估疗效。采用受试者工作特征曲线(ROC)及Kaplan-Meier生存函数的方法分析Treg动态变化与肿瘤无进展生存期的关系。结果 RFA术后1月,30例患者TR率93.3%(28/30),TP率6.67%例(2/30)。RFA术前Treg 9.42±1.16,术后1月6.55±0.97,较术前显著下降(t=15.325,P<0.001)。经12个月随访,TR率33.33%(10/30),TP率66.67%例(20/30)。TR组术前Treg为8.75±0.72,显著低于TP组9.76±1.20(t=-2.448,P=0.021)。ROC表明Treg谷值以4.82为最佳临界值时,敏感度为90.0%,特异度为60.0%;Treg达谷时间以5.5个月为最佳临界值,敏感度为70.0%,特异度为85.0%。采用Kaplan-Meier曲线分析表明,肝癌RFA术后Treg谷值≤4.82的肿瘤无进展生存率优于Treg谷值>4.82的患者;Treg达谷时间≥5.5个月的患者预后优于Treg达谷时间<5.5个月患者,Log-rank检验分别为X~2=8.209,P=0.004;X~2=8.427,P=0.004。结论冷循环射频消融可以下调Treg水平,并且Treg谷值及Treg达谷时间在一定程度上反映RFA治疗HCC患者的预后。更多还原

【Abstract】 Objective To evaluate the usefulness of the long-term surveillance of regulatory T cells kinetics in predicting the prognosis of patients with hepatocellular carcinoma after percutaneous cool-tip radiofrequency ablation(RFA) under ultrasound guidance.Methods We used the flow cytometry to test the percentage of regulatory T(Treg)cells in peripheral blood before RFA and after 1,4,7,12 months.The therapeutic effects were measured by contrast enhanced sonography or contrast enhanced computed tomography one month after RFA.The correlation between regulatory T cells and the prognosis of the patients with hepatocellular carcinoma after RFA wasanalyzed by receiver operating characteristic(ROC) curve and Kaplan-meier curves.Results 1 month after RTA,The ratio of tumor response(TR) from 30 hepatocellular carcinoma cases was 93.3%(28cases),while the ratio of tumor progression was 6.67%(2 cases).The percentage of Treg at 1month after RFA was 6.55±0.97,significantly lower than 9.42+1.16 before RFA(t=15.325,P<0.001).12 months after RFA,The ratio of TR was 33.33%(10 cases),while the ratio of TP was66.67%(20 cases).In the TR group the percentage of Treg before RFA was 8.75±0.72,significantly lower than 9.76±1.20 in the TP group(t=-2.448,P=0.021).With the help of ROC curves,we identified that the best cut-off of Treg nadir was 4.82(sensitivity 90.0%and specificity60.0%) and the best cut-off for time to Treg nadir was 5.5 months(sensitivity 70.0%and specificity 85.0%).With the analysis of Kaplan-meier curves,we identified thatprogression-free survival(PFS) of patients with Treg nadir lower than 4.82 was significantly increased compared with Treg nadir more than 4.82 andPFS of patients with time to Treg nadir more than 5.5 months was significantly increased compared withtime to Treg nadir less than 5.5 months.Conclusion RFA can decrease the percentage ofTreg cells.To some extent,the percentage of Treg cells kinetics is a prognostic factor in HCC patients with RFA.更多还原