| [Background and Objective]Primary liver cancer (PLC) is one of the most common malignant tumors of the world; it seriously affects human’s health and life expectancy. Its incidence ranks fifth in the global cancer, the incidence of cancer ranks second in men and fourth in women while China’s new cases of PLC occupied50%of the world’s each year. Among death toll caused by cancer, PLC ranked seventh in the men, and ninth in women. Hepatocellular carcinoma (HCC) accounted for90%of the primary liver cancer, at large about25million people died of HCC every year all over the word which accounts for about45%of our country.Surgery is the main method of radical treatment for HCC, however, as a result of HCC’s insidious onset, lack of typical early clinical symptoms, when most patients get into hospital it is too late for them to undertake surgeries. The other cause of low surgery rate is due to the majority of patients complicated with liver cirrhosis after hepatitis in our country, which make the number of patients who get surgical treatment decrease to20%～25%. The development of minimally invasive technology in recent years shaped lots of new treatments for unresectable HCC patients. Such as localized and minimally invasive therapy guided by type B ultrasonic or computerized tomography(CT), which including percutaneous transcatheter arterial embolization (TACE), radiofrequency ablation(RFA), percutaneous microwave coagulation therapy(PMCT) and so on.Transarterial chemoembolization was first introduced in1977by Dr. Yamada who found hepatocellular carcinoma is mainly nutrient by hepatic artery. Thus doctors can transmit anti-tumor drugs through hepatic artery for better treatment, and avoid damage the normal liver tissue around the tumor at the same time. In1987researchers found that poppy seed oil combined with iodine oil can generate organic iodized oil which can selectively uptaken by liver cancer cells, and can stored in the liver cancer cells, eventually lead necrosis to those cells. This gradually shaped into the conventional mode of transcatheter treatment, and had been quickly development and widely used. TACE mainly inject iodized via hepatic artery to the tumor to block the blood supply system of HCC while iodized oil can be selectively uptaken by cancer cells. Meanwhile by inject anticancer drugs to tumor through tumor feeding artery, TACE eventually damage the tumor.Percutaneous microwave coagulation therapy refers to a kind of treatment which use the microwave ablation needle under the guide of type B ultrasound or CT, then ablation needle can be introduced into the tumor through patient’s skin which destruct tumor by a certain frequency electromagnetic microwave.PMCT can lead the water molecules and particles in the tumor tissue to violently collision, which eventually lead completely necrosis to tumor cells. Microwave ablation technique was first reported in1979for liver rupture intraoperative bleeding, and in1994microwave was first reported for percutaneous ablation for small hepatocellular carcinoma. Microwave ablation has been widely used in a variety of unresectable tumors, and has achieved substantial results. Microwave ablation can effectively inactivate tumor tissue in treatment area, and have no effect on normal liver cells and peritumoral vascular tissue, meanwhile it have little effect on hepatic function of the patients.Leukocyte differentiation antigen refers to the blood cells surface markers which appearance or disappearance of different spectrum and different phase of cells. By clustering and analyzing leukocyte differentiation antigen of different laboratory to the same differentiation group (cluster of differentiation, CD). Through the identification of cell surface markers of different classification and the number of CD can assess the immune status of the individual.T lymphocytes (thymus dependent lymphocyte) are a group of small lymphocytes with immune activity. T lymphocyte cells derived from bone marrow stem cells T, transported through the bloodstream to the thymus, where T lymphocytes marked with CD and grow mature. Mature T lymphocytes were distributed via the bloodstream to the peripheral immune organs thymus-dependent immune responses play area, and lymphatic, blood and tissue fluids.CD3molecules expression in all the surface of T lymphocytes. T lymphocytes can be subdivided according to the different surface markers expressed subdivided into different subgroups, such as auxiliary/inducer T lymphocytes (CD3+CD4+T), suppressor/cytotoxic T lymphocytes (CD3+CD8+T). T lymphocyte’s function depends on the total quantity of the T lymphocytes (CD3+T) and its subsets (CD3+CD4+T and CD3+CD8+T). T lymphocytes are the main effectors molecules involved in the body’s cellular immune response, and cell-mediated immunity is the main mechanism of anti-tumor immunity, namely T lymphocytes in the body’s anti-tumor mechanisms play an important role.Domestic and international studies have shown that tumors can suppress immune function in patients, means that patients are immunosuppressed state which mainly due to tumor cells can discharge transforming growth factor-P (TGF-β), interleukin-10(IL-10) and other inhibitory cytokines that inhibit anti-tumor immune response. The peripheral blood lymphocyte such as CD3+T lymphocytes (i.e., the total number of T lymphocytes) and CD4+T/CD8+T ratio in hepatocellular carcinoma patients were found lower than normal people. The fact that liver cancer cells leads to the deterioration immune of patients immune system, can result in tumor progression. Domestic scholars owe different attitude toward weather TACE benefit HCC patient’s immune system or not. But research believe that microwave ablation can stimulate the body’s immune effect, reactivate immune cell which can enhance immune response of tumor, then strengthen the body’s own antitumor effect.Hepatic artery embolism chemotherapy combined with percutaneous microwave ablation in the treatment of liver cancer patients provides them with a more effective treatment, and improves the overall survival rate. But how to maximize the effect of joint application, minimize side effects are worth our deep discussion; and the effect of combination therapy on the patients’ immune system, as well as how to joint to improve immune function in patients have not been reported. Under this circumstance we carry on a prospective clinical and experimental study in31HCC patients.[Study methods]Subjects:From June2012to June2013, we selected31unresectable hepatocellular carcinoma patients in our hospital for the study. ALL of the tumor diameter≥5cm, Child-Pugh graded as A or Class B.Methods:The patients were randomly divided into A or B group, all patients treated with TACE first. Patients in group A treated with PMCT within10days after TACE therapy; patients in group A treated with PMCT within a month after TACE therapy. All patients in the combination therapy were evaluated before and after treated by CT; all patients peripheral blood T lymphocyte subsets conducted to evaluate before and after the combination therapy.[Results] 1.31cases were randomly divided into two groups,13cases in group A,18cases in group B. Basic information on the two groups were compared (gender, age, ECOG score, liver function Child-Pugh classification, tumor size and T lymphocyte ratio before treatment) equilibrium (P>0.05), no significant.2. tumor control rate:NO CR in31patients, PR21patients (66.7%), SD6patients (19.4%), PD4patients (12.9%).13cases of group A, the objective response rate ORR53.8%, disease control rate DCR76,9%;18patients in group B, objective response rate ORR77.8%, disease control rate DCR94.4%. No significant difference (X2=2.59, P=0.273>0.05) between tumor control rate of the two groups.3. T lymphocyte analysis:In group A, CD3+T lymphocytes, CD4+T/CD8+T lymphocyte ratio increased significantly after treatment; Group B, CD4+T/CD8+T lymphocyte ratio, CD3+CD4+T increased significantly after treatment. Single-factor repeated measures analysis of variance shows no difference between A and B.[Conclusion]Hepatic artery chemoembolization combined with percutaneous microwave ablation can enhance tumor control rate, and improve patient immune state. |
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