摘要
目的探讨立体定向体部放疗(SBRT)联合粒细胞-巨噬细胞集落刺激因子(GM-CSF)治疗原发性肝癌患者的效果。方法纳入接受SBRT联合GM-CSF治疗的31例原发性肝癌患者。观察治疗后患者的近期疗效(疾病控制率、客观缓解率)和远期疗效(无病生存期、总生存期),分析治疗前后患者的免疫指标(CD4^(+)T淋巴细胞水平、CD8^(+)T淋巴细胞水平及CD4^(+)/CD8^(+)值)、肝功能指标(ALT、AST、总胆红素、白蛋白水平)、肝癌指标(甲胎蛋白、癌胚抗原水平)、生活质量[Karnofsky功能状态(KPS)评分]的变化。结果治疗后1个月、3个月、6个月和12个月的客观缓解率分别为77.42%、90.00%、58.62%和40.74%,疾病控制率分别96.77%、93.33%、75.86%和70.37%。31例患者的中位无病生存期为9.1个月,中位总生存期为21.0个月。不同临床特征患者的中位无病生存期和中位总生存期差异均无统计学意义(均P>0.05)。与治疗前1周比较,治疗后1周患者的CD4^(+)T淋巴细胞水平、CD8^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)值、白蛋白水平下降,ALT、AST水平升高(均P<0.05);与治疗后1周比较,治疗后1个月、3个月患者的CD4^(+)T淋巴细胞水平、CD8^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)值升高(均P<0.05),而ALT、AST、白蛋白水平恢复至治疗前水平。治疗后1周、1个月、3个月患者的血清癌胚抗原、甲胎蛋白水平较治疗前1周有所下降,治疗后患者的KPS评分呈先降低后升高的趋势(均P<0.05)。结论SBRT联合GM-CSF可改善原发性肝癌患者的生活质量,维持患者肝功能的稳定,增强患者的免疫功能,提高患者远期临床疗效,可作为失去手术指征的原发性肝癌患者的治疗方案。
Objective To explore the effect of stereotactic body radiation therapy(SBRT)combined with granulocyte-macrophage colony-stimulating factor(GM-CSF)on patients with primary hepatic carcinoma.Methods Thirty-one patients with primary hepatic carcinoma who received SBRT combined with GM-CSF for treatment were enrolled.The post-treatment short-term efficacy(disease control rate and objective response rate),and long-term efficacy(disease-free survival and total survival)of patients were observed.Changes of pre-and post-treatment immune indices(CD4^(+)T lymphocyte level,CD8^(+)T lymphocyte level,and CD4^(+)/CD8^(+)value),hepatic function indices(levels of ALT,AST,total bilirubin,albumin),hepatic carcinoma indices(levels of alpha fetoprotein and carcino-embryonic antigen),and quality of life in terms of Karnofsky Performance Status(KPS)score were analyzed in patients.Results The objective response rates of 1,3,6 and 12 months after treatment were 77.42%,90.00%,58.62%,and 40.74%,respectively,and the disease control rates were 96.77%,93.33%,75.86%,and 70.37%,respectively.The median disease-free survival was 9.1 months,and the median total survival was 21.0 months in 31 patients.No statistically significant difference in median disease-free survival and median total survival was found between patients with different clinical features(all P>0.05).Compared with 1 week before treatment,CD4^(+)T lymphocyte level,CD8^(+)T lymphocyte level,CD4^(+)/CD8^(+)value,and albumin level were decreased in patients 1 week after treatment,whereas ALT and AST levels were elevated in patients 1 week after treatment(all P<0.05).Compared with 1 week after treatment,CD4^(+)T lymphocyte level,CD8^(+)T lymphocyte level,and CD4^(+)/CD8^(+)value were elevated in patients after 1 and 3 months of treatment(all P<0.05),whereas the levels of ALT,AST,and albumin returned to pre-treatment levels.The levels of serum carcino-embryonic antigen and alpha fetoprotein after 1 week,1 and 3 months of treatment were decreased as compared with 1 week before treatment,as well as KPS score of patients after treatment exhibited a tendency of first descending and then ascending(all P<0.05).Conclusion SBRT combined with GM-CSF can ameliorate quality of life in patients with primary hepatic carcinoma,maintain patients′hepatic function stability,enhance patients′immune function,and improve patients′long-term clinical efficacy;in addition,it can be regarded as a therapeutic regimen for patients with primary hepatic carcinoma who have lost surgical indications.
作者
周菲菲
黄荣
蒋军
赵晓昀
曾晓红
何瀚
陈默
ZHOU Feifei;HUANG Rong;JIANG Jun;ZHAO Xiaoyun;ZENG Xiaohong;HE Han;CHEN Mo(Department of Genitourinary Oncology,Cancer Hospital,the First People′s Hospital of Foshan,Foshan 528000,Guangdong,China)
出处
《广西医学》
CAS
2023年第12期1408-1413,共6页
Guangxi Medical Journal
基金
广东省基础与应用基础研究基金(2019A1515110677)。
关键词
原发性肝癌
立体定向体部放疗
粒细胞-巨噬细胞集落刺激因子
临床疗效
Primary hepatic carcinoma
Stereotactic body radiation therapy
Granulocyte-macrophage colony-stimulating factor
Clinical efficacy
