腹腔低渗热灌注联合FOLFOX6化疗对结肠癌根治术后外周血T淋巴细胞亚群和NK细胞的影响
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摘要
目的探讨结肠癌根治术后早期行腹腔低渗热灌注(HIPEC)联合FOLFOX6静脉化疗的临床效果及对患者T淋巴细胞亚群及自然杀伤细胞(NK)的影响作用。方法采用随机数字表将98例行结肠癌根治术患者分为观察组(HIPEC联合FOLFOX6静脉化疗)和对照组(FOLFOX6静脉化疗)各49例。对比两组患者的化疗效果及对患者免疫功能差异。结果观察组和对照组治疗前的KPS评分差异无统计学意义(P>0.05),治疗后观察组的KPS评分显著的高于对照组(P<0.05);观察组和对照组治疗前的CD3~+、CD4~+、CD8~+、CD4~+/CD8~+及NK细胞差异无统计学意义(P>0.05),治疗后观察组的CD3~+、CD4~+、CD4~+/CD8~+及NK细胞显著的高于对照组(P<0.05);观察组和对照组化疗过程中的恶心呕吐、腹痛腹泻、骨髓抑制、便秘、肝功能损害、肾功能损害发生率差异均无统计学意义(P>0.05);观察组术后2年的复发率(14.29%)显著的低于对照组的(34.69%)(P<0.05);两组患者2年随访的死亡率、存活率差异无统计学意义(P>0.05)。结论结肠癌根治术后早期行HIPEC联合FOLFOX6静脉化疗有利于改善患者的免疫功能、降低术后复发率、提高生存质量,但是对患者的远期生存率的影响尚需进一步延长观察时间。
Objective To investigate the clinical effect of hyperthermia combined with FOLFOX6 chemotherapy on peripheral blood T lymphocyte subsets and NK cells in colon cancer after radical resection. Methods 98 patients with colon cancer surgery were randomly divided into observation group( HIPEC joint FOLFOX6 intravenous chemotherapy) and control group( FOLFOX6 chemotherapy),each group with 49 patients. The immune function of patients in two groups were compared. Results KPS score before the treatment of the two groups had no statistically significant difference( P > 0. 05),KPS scores in the observation group after treatment were significantly higher than that of the control group(P < 0. 05). CD3~+,CD4~+,CD8~+,CD4~+/ CD8~+and NK cells of the two groups before treatment had no significant difference( P > 0. 05),CD3~+,CD4~+,CD4~+/ CD8~+and significantly were higher than those of NK cells after treatment in the observation group( P < 0. 05). During chemotherapy,nausea and vomiting,abdominal pain,diarrhea,bone marrow suppression,constipation,liver damage,kidney dysfunction incidence had no significant difference( P > 0. 05). 2- year recurrence rate( 14. 29%) in observation group was significantly lower than that of the control group( 34. 69%)( P < 0. 05). 2 years follow- up mortality and survival in the two groups had no significant difference( P > 0. 05).Conclusion HIPEC in early stage colon cancer after chemotherapy combined with FOLFOX6 can help to improve the patient's immune function,reduce the recurrence rate and improve the quality of life,but the impact on the patient's long- term survival needs to be further extended observation period.
Objective To investigate the clinical effect of hyperthermia combined with FOLFOX6 chemotherapy on peripheral blood T lymphocyte subsets and NK cells in colon cancer after radical resection. Methods 98 patients with colon cancer surgery were randomly divided into observation group( HIPEC joint FOLFOX6 intravenous chemotherapy) and control group( FOLFOX6 chemotherapy),each group with 49 patients. The immune function of patients in two groups were compared. Results KPS score before the treatment of the two groups had no statistically significant difference( P > 0. 05),KPS scores in the observation group after treatment were significantly higher than that of the control group(P < 0. 05). CD3~+,CD4~+,CD8~+,CD4~+/ CD8~+and NK cells of the two groups before treatment had no significant difference( P > 0. 05),CD3~+,CD4~+,CD4~+/ CD8~+and significantly were higher than those of NK cells after treatment in the observation group( P < 0. 05). During chemotherapy,nausea and vomiting,abdominal pain,diarrhea,bone marrow suppression,constipation,liver damage,kidney dysfunction incidence had no significant difference( P > 0. 05). 2- year recurrence rate( 14. 29%) in observation group was significantly lower than that of the control group( 34. 69%)( P < 0. 05). 2 years follow- up mortality and survival in the two groups had no significant difference( P > 0. 05).Conclusion HIPEC in early stage colon cancer after chemotherapy combined with FOLFOX6 can help to improve the patient's immune function,reduce the recurrence rate and improve the quality of life,but the impact on the patient's long- term survival needs to be further extended observation period.
引文
[1]俞进友,仇建玲,朱正峰,等.EOF方案化疗联合体外高频热疗治疗晚期原发性肝癌的临床观察[J].中国基层医药,2015,12(11):1635-1639.
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[4]陈耀庭,姚和瑞,孙宏亮,等.肝动脉灌注化疗联合热疗治疗肝门部胆管癌的临床价值[J].中山大学学报(医学科学版),2014,35(4):539-544.
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[9]颉宝平,李征,姚南,等.化疗联合热疗治疗晚期大肠癌疗效及安全性的Meta分析[J].中国循证医学杂志,2013,13(3):352-357.
[10]刘颖.腹腔灌注配合热疗治疗卵巢癌、胃癌与结肠癌的疗效观察与分析[J].湖南中医药大学学报,2013,33(8):28-29.
[11]郑鸿,陶莉,杨新苗,等.恩度加化疗联合局部热疗治疗恶性腹腔积液临床观察[J].实用肿瘤杂志,2012,27(5):496-498.
[12]沈健美,吴倩,张文涛.化疗联合热疗与单纯化疗治疗乳腺癌肺转移疗效的对比研究[J].肿瘤学杂志,2014,20(10):866-868.
[13]Lampl B,Leebmann H,Mayr M,et al.Rare diaphragmatic complications following cytoreductive surgery and HIPEC:report of two cases.[J].Surg Today,2014,44(2):383-386.
[14]Aoyagi T,Terracina KP,Raza A,et al.Current treatment options for colon cancer peritoneal carcinomatosis[J].World J Gastroenterol,2014,20(35):12493-12500.
[2]卞华慧,陈蕾,蒲汪旸,等.参附注射液联合FOLFIRI方案治疗晚期结肠癌的临床观察[J].临床和实验医学杂志,2015,14(12):1007-1010.
[3]王小文,钟美佐.FOLFOX4化疗联合全身热疗治疗晚期大肠癌的临床观察[J].临床军医杂志,2012,40(1):120-122.
[4]陈耀庭,姚和瑞,孙宏亮,等.肝动脉灌注化疗联合热疗治疗肝门部胆管癌的临床价值[J].中山大学学报(医学科学版),2014,35(4):539-544.
[5]Valle M,Federici O,Carboni F,et al.Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis:proposal and results from a prospective protocol study of prevention,surveillance and treatment[J].Eur J Surg Oncol,2014,40(8):950-956.
[6]郭俊召.全身热疗联合化疗治疗ⅢB/Ⅳ期非小细胞肺癌临床研究及荟萃分析[D].西安:第四军医大学,2013.
[7]卢庆刚,牟安娜,朱礼,等.局部热疗联合奥沙利铂、多西紫杉醇、5-氟尿嘧啶治疗晚期胃癌的临床随访研究[J].疑难病杂志,2014,(6):597-600.
[8]相洁,尹信,贾建厚,等.化疗联合全身热疗治疗Ⅳ期非小细胞肺癌临床观察[J].现代肿瘤医学,2014,12(9):2109-2112.
[9]颉宝平,李征,姚南,等.化疗联合热疗治疗晚期大肠癌疗效及安全性的Meta分析[J].中国循证医学杂志,2013,13(3):352-357.
[10]刘颖.腹腔灌注配合热疗治疗卵巢癌、胃癌与结肠癌的疗效观察与分析[J].湖南中医药大学学报,2013,33(8):28-29.
[11]郑鸿,陶莉,杨新苗,等.恩度加化疗联合局部热疗治疗恶性腹腔积液临床观察[J].实用肿瘤杂志,2012,27(5):496-498.
[12]沈健美,吴倩,张文涛.化疗联合热疗与单纯化疗治疗乳腺癌肺转移疗效的对比研究[J].肿瘤学杂志,2014,20(10):866-868.
[13]Lampl B,Leebmann H,Mayr M,et al.Rare diaphragmatic complications following cytoreductive surgery and HIPEC:report of two cases.[J].Surg Today,2014,44(2):383-386.
[14]Aoyagi T,Terracina KP,Raza A,et al.Current treatment options for colon cancer peritoneal carcinomatosis[J].World J Gastroenterol,2014,20(35):12493-12500.