Analysis On Effect Of TACE Combined RFA With Cytokine Induced Killer Cells In Treatment Of Medium And Small Hepatocellular Carcinoma

Objective:This study collected the clinical data of patients with HCC(medium and small hepatocellular carcinoma)by treatment of TACE combined RFA with or without CIK cells transfusion,compared the two groups with clinical data such as the quality of life,T lymphocyte subsets,liver function,postoperative progression free survival,overall survival and image changes,to study the clinical efficacy of TACE combined RFA with CIK cells transfusion in treatment of HCC.Then further explore the mechanism of CIK cells.Methods:From October 2012 to January 2017 in the First Affiliated Hospital of Kunming Medical University,63 patients of primary medium and small hepatocellular carcinoma(HCC)accept interventional therapy were collected and randomly divided into two groups,the study group(TACE+RFA+CIK)of 31 patients and control group(TACE+RFA)of 32 patients.Before operation all patients underwent routine blood test,liver and kidney function,Coagulation function,Hepatitis virus test,Alpha fetoprotein,Detection of T lymphocyte subsets,electrocardiogram,abdominal CT/MRI examination.Before operation the patients in the study group draw autologous peripheral blood,and the CIK cells were isolated and cultured in the Biotherapy Center.All patients were treated with TACE and RFA 3 or 5 days after TACE.the study group Patients were treated with CIK cells transfusion through the peripheral venous route within 30 minutes after the completion of the separation of CIK cells,Close observation of patients with adverse reactions.The CIK cell transfusion every one times a day,continue of 3 days,one times a month,every 3 months is one course.The second of CIK cell therapy treatment were treated 6 months after operation.Alpha fetoprotein,liver function,routine blood test and Coagulation function were examined every 2 months after operation.Abdominal CT or MRI examinations were performed every 6 months.T lymphocyte subsets were detected 6,12,18,24,36 months after operation,respectively.If the review found that of residual lesions,local tumor progression or other parts of the new lesions,and then treated with interventional therapy.regular follow-up,the follow-up period was 3 years(to January 2017),the follow-up terminate of death.The quality of life(QOL),immune function,liver function,postoperative progression free survival,overall survival and image changes were compared between the two groups.Results:1.Changes of Karnofsky The effective rate of Karnofsky score in the study group was 76%,while the control group was 47.6%.the quality of life was significantly improved in the study group Compared with the control groups(P<0.05).2.Changes of T lymphocyte subsets There was no statistical significance in CD3+,CD4+,CD8+T cells and CD4+/CD8+T cell ratio between the study group and the control group before treatment(p>0.05).The CD3+T,CD4+T cells and CD4+/CD8+T cell ratio increased gradually 6,12,18 and 24 moths after treatment,and the CD8+T cells decreased gradually,the difference was statistically significant compared with preoperative(p<0.05).The changes of the indexes in the control group 6 months after therapy were statistically significant compared with Preoperative(P<0.05).There was no significant difference 12,18,24 and 36 months after therapy.3.Liver function The study group before and after the treatment,ALT,AST,TB were 41.1± 19.1 and 41.2 ± 16.3 IU/L,39.7 ± 17.7 and 37.9 ± 12.8 IU/L,17.2±7.4 and 17.9 ±7.5 ?mol/L respectively,The difference was not statistically significant(P>0.05).While the control group were 44.8±18.8 and 51.4± 15.5 IU/L,44.9±16.0 and 50.0 ± 15.1 IU/L,The difference was statistically significant(P<0.05),TB were 16.2± 5.7 and 15.3 ± 4.8?mol/L respectively,The difference was not statistically significant(P>0.05).4.Progression free survival(PFS)In the study group the median progression free survival(mPFS)is 34 months(95%CI 30.9-37.1 months),while the control group 26 months(95%CI 22.9-29.1 months),the two groups were statistically significant differences(P<0.05).Cox multivariate analysis showed that whether combined with CIK cells therapy is independent prognostic factors of Progression free survival in patients of medium and small hepatocellular carcinoma.5.survival rate The 1-,2-,3-year survival rates of the study group and the control group were 100%,90.3%,80.6%and 96.9%,84.4%,65.6%respectively.The survival rate of the study group was significantly higher than that of the control group(P<0.05).6.Imaging evaluation The CR,PR,SD and PD in the study group were 16,5,2,2,while the control group were 12,3,2,4.The effective rate was 67.7%in the study group while 46.9%in the control group.Conclusions:1.It have good curative effect that TACE combined RFA with CIK cells and TACE jointed RFA in the treatment of medium and small hepatocellular carcinoma.2.TACE combined RFA with CIK cells can improve the immune function of patients with hepatocellular carcinoma,which obviously better than that of TACE combined with RFA.3.Compared to TACE jointed RFA,TACE combined RFA with CIK cells can prolong progression free survival and overall survival in patients with medium and small hepatocellular carcinoma.4.Cox multivariate analysis showed that whether jointed CIK cell therapy is independent prognostic factors for progression free survival in patients with medium and small hepatocellular carcinoma.