| Objectives 1 To evaluate the effects of percutaneous cryoablation on the CD3~+,CD4~+,CD8~+,and CD4~+/CD8~+T lymphocyte subsets in single-cycle group and double-cycles group.To evaluate the effect of two freezing parameters on immune function.2 The intraoperative freezing rate and postoperative efficacy of the single-cycle group and the double-cycles group were statistically analyzed and compared.Clinical efficacy was evaluated and the effect of cryoablation on Non Cell Lung Cancer was evaluated.3 The intraoperative and postoperative complications of all patients were counted and their safety was evaluated.Methods 120 patients diagnosed Non-Small Cell Lung Cancer who received cryoablation and met the inclusion criteria at the Cancer Treatment Center of the First Hospital of Hebei Medical University from November 2015 to October 2017 were randomized to undergo intraoperative frozen parameters 15 minutes of single-cycle or 15 minutes of double-cycles treatment.Flow cytometry was used to detect T lymphocyte subsets in peripheral blood of all patients on the previous day of cryotherapy,in treatment after seven days and in cryotherapy after thirty days.The differences of CD3~+,CD4~+,CD8~+,and CD4~+/CD8~+ratios were compared between the two groups.All patients underwent cryosurgery to measure the proportion of ice-bulk formation volume in the target volume by CT during the cryotherapy procedure.The intraoperative ablation rate was evaluated and compared according to lesions size from<2cm,2-4cm to 4-5cm.All patients used CT measurements of the ablation area and lesion size at first month and third month after cryotherapy,and evaluated the short-term efficacy of ablation therapy.To observe and summarize the complications during and after cryotherapy treatment and evaluate the safety.The SPSS(Social Science Statistics Package)19.0 statistical software was used for analysis.Measured data were analyzed by mean±standard deviation,and the rates were compared using chi-square test.All data were compared prior to normality and homogeneity of variance tests.Two independent sample t-tests were used to compare the data between the two groups.Rank sum test is used for rank date.One-way analysis of variance(ANOVA)was used to compare the means of multiple groups,and the LSD test was used to compare the means between the two groups.All statistical results were statistically significant at P<0.05.Results 1 Baseline comparison between the two groups:There was no statistical difference in patient gender,age,KPS score,tumor size,and lesion location between the single-cycle group and the double--cycles group.2 Changes in T lymphocyte subsets:CD3~+,CD4~+,and CD4~+/CD8~+levels increased gradually in the single-cycle group and the double--cycles group.The CD3~+,CD4~+,CD4~+/CD8~+levels in the peripheral blood were significantly higher in the double-cycle group than in the single-cycle group.There were significant differences between the two groups in the postoperative seven days and the postoperative thirty days.In both groups,CD8~+decreased gradually in postoperative time.There was a statistically significant difference between the seven days and thirty days postoperatively.However,the increase of CD3~+,CD4~+,CD4~+/CD8~+,CD8~+were more significant in the double-cycles group.3 The evaluation index of in the ablation rate of intraoperative tumors:single-cycle group,intraoperative effective rate of<2cm tumor was 100%;2-4cm tumor effective rate was 100%;4-5cm tumor efficiency is 90%.In the double-cycles group,the effective rate of tumors<2 cm was 100%;the effective rate of2-4 cm tumors was 100%;the effective rate of 4-5 cm tumors was 94.11%.There was no difference between the two groups in the<2cm,2-4cm,and 4-5cm groups.4 Changes in CT value after cryotherapy:The preoperative CT value of the single-cycle group was60.70±4.65 Hu,and it was 31.44±5.21 Hu and 30.18±3.78 Hu respectively after 30 days of cryopreservation and 3 months after cryopreservation;in the double-cycles group the CT value before cryopreservation was 59.04±4.51 Hu.The enhanced CT values at first month and third month after operation were 30.94±5.14 Hu and 30.56±4.82 Hu.The preoperative and postoperative first month and third month.There was no significant difference in the same month,P values were>0.05.5 Comparison of tumor size changes after cryoablation:The long diameter of the tumor in the single-cycle group was 4.02±1.41 cm before cryotherapy,and the maximum width was 3.78±1.30 cm.The long diameter of the tumor before cryotherapy in the double-cycle group was 2.61.±1.42 cm,the maximum width was 3.60±1.11 cm.There was no significant difference in the length and width of tumor between the two groups,P>0.05.At 30 days after cryoablation,the long diameter and wide diameter of the two groups were smaller than before cryotherapy(P<0.05).Frozen ablation lesions after cryotherapy:in single-cycle group CR at third months,PR 36 cases,NC 16 cases,PD 5 cases,the effective rate was 91.67%;in double-cycle group the frozen at first month after ablation CR was 4 cases,PR 37 cases,NC 15 cases,PD 4 cases,the effective rate was 93.33%,two groups p>0.05.In the single-cycle group,there were12 cases of CR,30 cases of PR,13 cases of NC,and 6 cases of PD.The effective rate was 90.00%in the single-cycle group;CR was 12 cases and PR was 1 month after ablation in the double-cycle group.There were 28 cases,15 cases of NC,and 5 cases of PD.The effective rate was 91.67%.The two groups compared have no significant difference p>0.05.6 All 120 patients were successfully treated and none died.The main complications were pneumothorax,pleural effusion,hemorrhagic blood or hemoptysis in sputum,prehypertension,hyponatremia,and fever,accounting for 16.66%,14.16%,31.66%,30.83%,and 20.83%,respectively.Among them,subcutaneous emphysema accounted for 20.00%(2/20)of patients with pneumothorax.The long-term complications were skin numbness around the wound and local pain at the incision,totaling 32.50%(39/120),respectively 25.00%and 7.50%.Conclusions Cryoablation treatment of non-small cell lung cancer,single-cycle and double-cycles through T-lymphocyte subsets reflect the improvement of immune function.Using T-lymphocyte subsets as indicators,the double-cycle group had better immune response than the single-cycle group.In the treatment of non-small cell lung cancer by cryoablation,there was no significant difference in the range of intraoperative ablation within single-cycle and double-cycles of intraoperative ablation,and the decrease in tumor size and CT value at first month and third months postoperatively.Cryoablation treatment of non-small cell lung cancer complications are mainly pneumothorax,pleural effusion,sputum with blood or hemoptysis than before ablation,hyponatremia,fever and so on. |
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