CIK细胞回输联合吉西他滨和顺铂治疗鼻咽癌放疗后肝肺转移瘤的效果及机制研究

摘要

AIM : To evaluate the recent and long - term efficacy of cytokine - induced killer( CIK ) cell and transfusion plus chemotherapy with gemcitabine and cisplatin( GP ) for patients of nasopharyngeal carcinoma( NPC ) with hepatic or pulmonary metastasis.METHODS: From Aug.2007 to Jul.2008, 30 patients of nasopharyngeal carcinoma with hepatic or pulmonary metastasis were enrolled in the study and randomly divided into 3 groups.Ten patients( CIK + GP group ) received CIK cell transfusion plus GP chemotherapy for 4 cycles.Another 10 patients( GP group )received the regimen of GP chemotherapy alone.The other 10 patients as well as 10 healthy volunteers did not receive any anti - cancer treatment.The early response, the changes of serum EBV - DNA by quantitative PCR detection and distribution of lympholeukocyte subset in the patients of the 3 groups were determined before and after treatment.The long - term effects were observed in a follow - up process of 2 vears.RESULTS : The recent complete and partial response( CR + PR ) rates were 90％, 70％ and 10％ in CIK + GP group, GP group and patient control group, respectively, and obviously statistical differences among these 3 groups were observed.The proportion of CD3 + lymphocytes in NPC patients with hepatic or pulmonary metastasis were obviously lower than that in healthy volunteer.It also descended after CIK + GP/GP therapy, but partly recovered in CIK + GP group.Furthermore, no statistical difference of CD4 + /CD8+ ratio among NPC patients with hepatic or pulmonary metastasis and volunteers was found.The ratio of CD4 + /CD8+ in CIK + GP group increased.but decreased in GP group after treatment.In the 2 - year follow - up, the overall survival rate was 60.0％ , 40.0％ and 20.0％in CIK + GP, GP and control group , respectively.The Kaplan - Meier survival curves showed statistical difference.CONCLUSION : The recent and long - term effects of CIK cell transfusion comhined with GP chemotherapy for patients of NPC with hepatic or pulmonary metastasis have been confirmed.The chemotherapy and biotherapy of CIK + GP improve the prognosis with synergistic effects, possibly owing to the changed proportion of CD3 + and ratio of CD4 + /CD8+ .%目的:观察评价细胞因子诱导杀伤(CIK)细胞回输联合吉西他滨和顺铂(GP)方案化疗治疗鼻咽癌放疗后肝肺转移瘤的近远期疗效,并探讨其机制.方法:2007年8月至2008年7月放疗后随访发现肝或肺转移患者30例,随机分为3组.研究1组10例行过继性CIK细胞回输联合GP化疗;研究2组10例行单纯GP化疗.对照组患者及健康志愿者各10例,不给予抗肿瘤治疗而仅进行随访.观察其近远期疗效、血清EB病毒DNA PCR定量和外周血淋巴细胞亚群分布变化.结果:CIK+GP组有效率(90%)比单纯GP组(70%)好,但2组间无明显差异;而CIK+GP组和GP组均比对照组(10%)好,差异明显.CIK+GP组最和GP组治疗后血清EBV-DNA PCR定量均有不同程度的下降,尤以CIK+GP组为明显,而对照组则无明显改变.鼻咽癌放疗后肝肺转移瘤患者外周血CD3+比例较健康志愿者显著低下,经CIK+GP治疗后CD3+比例较单纯GP化疗组有所提高;肝肺转移瘤患者和健康志愿者CD4+/CD8+比例无明显差异,经CIK+GP生物化疗后其比例明显升高,而经GP化疗后明显降低,2组之间存在明显差异.CIK+GP组、GP组和对照组2年生存率(OS)分别为60.0%、40.0%和20.0%,生存曲线分析显示3组病例之间均有明显差异(P＜0.05).结论:CIK 细胞回输联合GP 化疗治疗鼻咽癌放疗后肝肺转移瘤具有肯定的近远期疗效并可改善其预后;两者具有协同作用,其作用可能与改变CD3+及CD4+/CD8+比例有关.