清瘤亮喉方在辅助治疗喉咽癌中对免疫功能的影响

摘要

目的 探讨清瘤亮喉方在辅助治疗喉咽癌中对免疫功能的影响.方法 喉咽鳞状细胞癌患者156例,Ⅰ期21例、Ⅱ期34例、Ⅲ期55例、Ⅳ期46例,其中手术+放疗31例,手术+放疗+中药40例,放疗剂量为60 Gy;放、化疗45例,放、化疗+中药40例,放疗剂量为70 Gy,化疗方案为顺铂+氟尿嘧啶,4～6周期.中药为口服清瘤亮喉方制剂,连服12周.应用流式细胞仪检测外周静脉血淋巴细胞亚群和NK细胞活性变化.结果 手术+放疗患者,治疗结束后免疫功能下降,以总T细胞、辅助T细胞和NK细胞降低为主,同步放、化疗患者,治疗后免疫功能降低更加严重,表现在总T细胞、辅助T细胞、辅助/抑制T细胞比值和NK细胞活性降低,抑制T细胞升高(P＜0.01,P＜0.05).口服中药患者,治疗前后T淋巴细胞亚群和NK细胞活性变化不著.手术放疗后及同步放化疗后患者KPS评分均降低;加服中药组治疗后KPS评分均高于未加服中药组(P＜0.05).手术+放疗患者3年复发率为41.94％,手术+放疗+中药患者3年复发率为20.00％ (P＜0.05);放、化疗患者3年复发率为60.00％,放、化疗+中药患者3年复发率为37.50％ (P＜0.05).手术+放疗患者5年生存率为38.71％,手术+放疗+中药患者5年生存率为62.50％ (P＜0.05);放、化疗患者5年生存率为22.22％,放、化疗+中药患者5年生存率为42.50％ (P＜0.05).结论 清瘤亮喉方能有效减轻喉咽癌综合治疗中免疫功能降低的程度,应用清瘤亮喉方的中西医结合治疗喉咽癌可延缓肿瘤复发,延长患者的寿命.%OBJECTIVE To study the effect of Qingliu Lianghou Fang on immune function of hypopharyngeal carcinoma. METHODS A total of 156 patients with hypopharyngeal squamous cell carcinoma were include. There were 21 stage I cases, 34 stage II cases, 55 stage III cases and 46 stage IV cases. Thirty-one patients were managed with surgery and post-operative radiotherapy, 40 cases with surgery , post-operative radiotherapy and Qingliu Lianghou Fang treatment. A total dose of radiotherapy was 60 Gy. Forty-five patients were managed with concomitant chemoradiotherapy, 40 cases with concomitant chemo-radiation and Qingliu Lianghou Fang treatment. A total dose of radiotherapy was 70 Gy. The drugs of chemotherapy were cis-platin + 5-FU. Qingliulianghou decoction was taken orally for 12 weeks. Prostecdtive efficacy and toxicity were evaluated. Peripheral blood lymphocyte subsets were detected with flow cytometry. RESULTS The immune function in patients with surgery and post-operative radiotherapy was lower, such as total T lymphocytes, helper lymphocyte subsets and NK activity. The immune function in patients with concomitant chemoradiotherapy was lower than those with surgery and post-operative radiotherapy. For example, total T lymphocytes, helper lymphocyte, helper/suppressor ratios and NK activity decreased, but suppressor lymphocytes increased. Before and after treatment , there was no marked change in T-lymphocyte subsets and NK activity in patients with Qingliu Lianghou Fang treatment. The KPS score of patients with post-operative radiotherapy and concomitant chemoradiotherapy decreased obviously with significant difference. KPS score in Qingliu Lianghou Fang treatment group decreased lightly, even more important , KPS score in Qingliu Lianghou Fang treatment group were significantly higher than in nonQingliu Lianghou Fang treatment group(P<0.05). The 3-year recurrence rate of patients with surgery and post-operative radiotherapy was 41.94%. While the patients with surgery , post-operative radiotherapy and Qingliu Lianghou Fang treatment was just 20.00% (P<0.05). The 3-year recurrence rate of patients with concomitant chemoradiotherapy was 60. 00%, while the patients with concomitant chemoradiotherapy and Qingliu Lianghou Fang treatment was just 37. 50% (P< 0.05). The 5-year survival rate of patients with surgery and post-operative radiotherapy was 38.71%. On the other hand, the 5-year survival rate of patients was 62.50% with surgery , post-operative radiotherapy and Qingliu Lianghou Fang treatment(P <0.05). The 5-year survival rate of patients with concomitant chemoradiotherapy was 22.22%, while the patients with concomitant chemoradiotherapy and Qingliu Lianghou Fang treatment could reach up to 42.50%(P<0.05). CONCLUSION The combination therapy of the traditional Chinese medicine with hypopharyngeal carcinoma treatment can effectively prevent and reduce the decrease of immune function caused by surgery, radiotherapy and chemotherapy. The combination therapy of the traditional Chinese medicine and Western medicine has the ability to prevent the recurrence and prolong the lifespan. Therefore we should realize that adjunctive therapy of hypopharyngeal carcinoma with Qingliu Lianghou Fang must not be overlooked.