目的 观察自体细胞因子诱导的杀伤(CIK)细胞回输治疗在肝动脉化疗栓塞(TACE)联合射频消融(RFA)序贯治疗肝细胞癌(HCC)中的临床获益情况并进行相关因素分析.方法 收集2004年9月1日至2006年12月31日在中山大学肿瘤防治中心影像介入中心就诊的95例HCC患者,接受TACE联合RFA治疗,在临床评价获得完全缓解的患者中,48例接受6次以上的CIK回输治疗(研究组),其余47例不接受其他治疗(对照组).随访期限不少于3年,首要观察终点为患者的生存期限(OS);次要观察终点为无疾病生存期( DFS).结果 共有76例患者完成全部治疗及随访(研究组38例,对照组38例),平均随访时长44个月(10 ~ 88个月).两组患者未出现因治疗死亡病例和严重并发症.研究组DFS为1、2及3年的比例为79%、26%及16%,中位DFS为28个月,平均为32个月(9~58个月);对照组相应数据为71%、21%及8%,中位DFS为22个月,平均23个月(6~53个月),两组比较差异有统计学意义(P=0.001).生存期限,研究组中位生存期为38个月,平均生存期为42个月(12 ~ 88个月),1、3及5年生存率分别为92%、53%及26%;对照组为35、37个月(10 ~71个月),89%、42%、24%,两组比较差异无统计学意义(P=0.099).美国东部肿瘤协作组(ECOG)评分、治疗方式和乙肝病毒(HBV)感染是影响DFS的预后因素;影响OS的预后因素仅有ECOG评分.结论 在TACE联合RFA的序贯治疗模式基础之上再联合CIK细胞回输治疗HCC,延长了DFS,减少复发HCC的TACE和消融治疗干预次数.
Objective To assess the long-term efficacy and investigate the prognostic factors of cytokine-induced killer (CIK) combined with the sequential transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) on hepatocellular carcinoma (HCC).Method A total of 95 HCC patients with the informed consents received TACE combined with RFA,48 cases of which accepted the CIK via intravenous drop infusion for more than 6 times (study group) while the other 47 cases were enrolled in control group.The following-up duration was more than 3 years.Primary endpoint was the overall survival (OS) and the secondary endpoint was the disease-free survival (DFS).Results 76 patients in all (38 in study group,38 in control group) complied with the study and follow-up (44months in median,10-88 months).No mortality and serve complications were observed in both groups.The ratio for patients with DFS over 1-year,3-year and 5-year were 79%,26% and 16% (28 months in median and 32.3 months in mean) while 71%,21% and 8% (22 months in median and 23.1 months in mean) for the control group.There was significant difference between the two groups (P =0.001 ).For the OS,the ratio for 1-year,3-year and 5-year in the study group were 92%,53% and 26% (38 months in median and 42.5 in mean) and 89%,42% and 24% (35months in median and 37 in mean).No significant difference was observed in both groups.ECOG performance status,Hepatitis B virus infection and treatment were the prognostic factors for DFS while ECOG performance status was the only prognosis for OS.Conclusion CIK infusion basing on the TACE combined with RFA can control the recurrence of HCC,decrease the times of TACE or RFA.