| ObjectiveAfter TACE,the tumor is not completely necrotic,and a large number of cancer cells remain and recur in tumor microenvironment.In recent years,programmed cell death receptor PD-1 is considered to be one of the most important pathways for tumor immune escape.Contrast-enhanced ultrasound(CEUS)has become a first-line imaging method to evaluate the effect of interventional therapy for primary liver cancer.In this study,CEUS combined with peripheral blood PD-1 was used to explore the relationship between the change level of TACE before and after TACE treatment of primary liver cancer and the curative effect,and whether the combination of CEUS and PD-1 has a better prognosis for patients with primary liver cancer.Methods(1)From October 2018 to October 2019,30 inpatients in hepatobiliary surgery of our hospital were selected.All patients had complete clinical data and history of hepatitis B.the inclusion criteria were as follows:① single primary liver cancer(tumor diameter>5cm);② patients refused to operate or were not suitable for operation and received TACE treatment;③ child Pugh grade was a;④ all patients had pathology before operation and confirmed as hepatocarcinoma;⑤No serious cardiopulmonary,cerebral and renal insufficiency;⑥no serious coagulation dysfunction;⑦ the estimated survival time is more than 3 months;⑧ no history of drug allergy related to TACE treatment;⑨ no previous history of anti-tumor related immunotherapy.(2)TACE for liver cancer:interventional doctors use Seldinger technology to perform TACE.The therapeutic effect of TACE was evaluated by rescist.(3)Using GE Logiq-E9 wire ultrasonic diagnostic instrument,the probe is C1-5.SonoVue was selected as the contrast agent to observe the blood perfusion of the focus continuously and dynamically.The echo intensity in the focus and the contrast with the surrounding tissue were observed.The enhancement mode,the time of starting enhancement and the intensity of enhancement were recorded.Contrast-enhanced ultrasound was performed before TACE treatment and 3 months after TACE treatment.(4)Detection of PD-1:flow cytometry was used to observe the expression of PD-1 on the surface of CD8+T and CD4+T cells.5-10ml peripheral blood was collected by the same nurse before and 3 months after TACE and sent to the laboratory for detection.Results(1)Comparison of clinical data before TACE treatment and 3 months after TACE treatment:before TACE treatment,there were 3 cases of metastasis(2 cases of metastasis to lung,1 case of stomach),27 cases were limited to single focus in liver.There were 17 cases of high to medium differentiation liver cancer and 13 cases of low differentiation liver cancer.After TACE treatment,AFP level decreased significantly(P<0.05),and tumor diameter did not decrease significantly(P>0.05)(2)(two)contrast-enhanced ultrasound before and after TACE treatment in March:before TACE treatment in 30 patients,contrast-enhanced ultrasound showed that 13 patients with low differentiated liver cancer showed fast in and fast out,and 17 patients with high to medium differentiated liver cancer mainly showed fast in and slow out.After TACE treatment for 3 months,reexamination of contrast-enhanced ultrasound showed that the enhancement range of the above lesions was unequal smaller than that before treatment.The main manifestations of poorly differentiated liver cancer were peripheral irregular or small mass enhancement.The main manifestations of moderately and moderately differentiated liver cancer were peripheral irregular enhancement in 12 cases,internal irregular enhancement in 1 case and peripheral small mass enhancement in 4 cases.After TACE treatment,the enhancement time increased and the enhancement intensity decreased.(3)Comparison of PD-1 expression levels before and after TACE treatment:before and after TACE treatment,PD-1 expression on CD8+T cells and CD4+T cells decreased in varying degrees(P>0.05).(4)Three months after TACE treatment,4 patients showed partial remission,10 patients were in stable state,16 patients had tumor progression,and the remission rate was about 46.7%.After TACE treatment for 3 months,the expression level of PD-1 on CD8+T cells of 16 patients with tumor progression was significantly increased(P<0.05).(5)The relationship between the degree of pathological differentiation and the level of PD-1 expression:before and after TACE treatment,the level of PD-1 expression on CD8+T cells in 17 patients with high to medium differentiation liver cancer decreased significantly(P<0.05),while before and after TACE treatment,the level of PD-1 expression on CD8+T cells in patients with low differentiation liver cancer increased significantly(P<0.05).(6)Correlation between PD-1 and contrast-enhanced ultrasound before and after TACE:correlation analysis showed that PD-1 on CD8+T cells was negatively correlated with contrast-enhanced time,but not significantly correlated with enhanced intensity.There was no significant correlation between PD-1 on CD4+T cells and contrast-enhanced time and intensity.ConclusionFirst,embolization of hepatic artery has certain effect on primary liver cancer with tumor diameter larger than 5cm,but it can not completely control tumor progression,so it is necessary to combine other treatment methods to develop the best treatment strategy.Secondly,contrast-enhanced ultrasound was used to observe the blood supply in and around the focus after TACE treatment,so as to accurately evaluate whether there was residual in the focus after TACE treatment.Third,the expression of PD-1 in the peripheral blood of patients with liver cancer is increased,which is related to the degree of tumor differentiation and treatment effect.The expression of PD-1 in the peripheral blood of patients with low differentiation tumor is higher,which has important clinical significance for the analysis of the severity of the disease.Fourthly,contrast-enhanced ultrasound combined with PD-1 expression is helpful for early and comprehensive judgment of patients’ condition and prognosis. |
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