目的 探讨微波消融(MWA)联合抗细胞程序性死亡受体-1(PD-1)抗体治疗原发性肝癌(PLC)患者的疗效.方法 2019 年6 月~2020 年12 月我院收治的PLC患者102 例,被分为对照组51 例和观察组51 例,分别接受MWA治疗或在MWA治疗的基础上应用信迪利单抗治疗6 个月.采用SF-36 量表评估生活质量,使用流式细胞仪检测外周血淋巴细胞亚群.随访1 年.结果 观察组客观有效率(ORR)为51.0%,显著高于对照组的29.4%(P<0.05);治疗后,观察组身体机能、生理职能、躯体疼痛、总体健康、精力、社会功能、角色限制和精神健康评分显著高于对照组(P<0.05);观察组外周血CD4+细胞百分比和CD4+/CD8+比值显著高于对照组(P<0.05),而CD4+CD25+FOXP3+Treg细胞和CD8+细胞百分比显著低于对照组(P<0.05);经Kaplan-Meier分析,观察组中位无进展生存率为9.7(95%CI:7.971~11.429)个月,对照组为7.8(95%CI:5.931~9.729)个月,观察组1a生存率为58.8%,显著高于对照组的37.3%(P<0.05).结论 在MWA治疗的基础上联合抗PD-1 抗体治疗PLC患者能提高疗效,可能与纠正了免疫功能紊乱有关.
Objective The purpose of this study was to investigate the efficacy of microwave ablation(MWA)and anti-programmed death receptor-1(PD-1)antibody therapy in patients with primary liver cancer(PLC).Methods A total of 102 patients with PLC were encountered in our hospital between June 2019 and December 2020,and were randomly divided into control(n=51)and observation group(n=51),receiving MWA or sintilimab immediately after MWA for six months.The quality of life was evaluated by 36-item shot-form health status survey(SF-36).The peripheral blood lymphocyte subsets was analyzed by FCM.All patients after therapy was followed-up for one year.Results The objective remission rate(ORR)in the observation group was much higher than in the control group(51.%vs.29.4%,P<0.05);at the end of six-month therapy,the physical function,physiological role,body pain,overall health,energy,social function,role limitation and mental health scores in the observation were significantly higher than in the control(P<0.05);the percentage of peripheral blood CD4+ cells and the CD4+/CD8+ cell ratio in the observation were much higher than in the control(P<0.05),while the percentage of CD4+CD25+FOXP3+ Treg cells and CD8+ cells were much lower than in the control(P<0.05);the Kaplan-Meier analysis showed that the median progression-free survival(PFS)in the observation group was 9.7(95%CI:7.971-11.429)mon,much longer than 7.8(95%CI:5.931-9.729)mon,and the one-year survival rate was 58.8%,also much higher than 37.3%(P<0.05)in the control group.Conclusion The administration of sintilimab immediately after MWA in treatment of patients with PLC is efficacious,which might be related to modulation of disturbed immune functions.