胸腺肽α1对伴MVI的肝细胞癌患者解剖性肝切除术后免疫功能和预后的影响OACSTPCD
Effects of postoperative thymosin alpha-1 treatment on immune function and prognosis in patients with hepatocellular carcinoma accompanied by microvascular invasion(MVI)after anatomical liver resection
目的 探讨解剖性肝切除术后应用非特异性免疫调节剂胸腺肽α1(Tα1)治疗对伴有微血管侵犯(MVI)的肝细胞癌(HCC)患者免疫功能和预后的影响.方法 回顾性分析2017年3月至2021年6月在内江市第一人民医院行解剖性肝切除术,术后病理为HCC伴MVI的106例患者临床资料.按术后是否联合应用Tα1,将患者分为Tα1治疗组(Tα1组,49例)和常规治疗组(常规组,57例).比较两组术前及术后1、3、6个月外周血T淋巴细胞亚群数量百分比和中性粒细胞与淋巴细胞比值(NLR)变化;比较两组肿瘤1年复发率及无复发生存率情况;分析影响HCC患者术后复发的预后因素.结果 (1)Tα1组患者术后CD3+、CD4+、CD4+/CD8+均明显高于常规组(F=10.336,16.541,16.397;均P＜0.05);两组术后CD8+比较差异无统计学意义(F=0.638,P=0.426).Tα1 组CD3+、CD4+、CD4+/CD8+术后即明显高于术前水平(P＜0.05),CD8+明显低于术前水平(P＜0.05).常规组在术后6个月时,CD3+、CD4+明显高于术前水平(P＜0.05),CD8+明显低于术前水平(P＜0.05);CD4+/CD8+在术后3、6个月明显高于术前水平(P＜0.05).(2)Tα1组患者NLR在术后1、3、6个月下降率明显高于常规组(x2=9.811,10.271,10.120;P＜0.05).(3)Tα1组术后1年复发率为18.4％,常规组为26.3％,两组比较差异无统计学意义(x2=0.950,P=0.330);Tα1组术后无复发生存率优于常规组(x2=4.348,P＜0.05).(4)多因素Cox分析结果显示:术后应用Tα1是一个显著影响HCC患者术后复发的独立预后因素(OR=0.554,95％CI0.317-0.967,P=0.038).结论 Tα1可以通过调节炎症和免疫状态,提高伴有MVI的HCC患者在解剖性肝切除术后的无复发生存率,使患者生存预后获益.
Objective To investigate the impact of postoperative treatment with non-specific immune modulators thymosin alpha-1(Ta1)on the immune function and prognosis in patients with hepatocellular carcinoma(HCC)accompanied by microvascular invasion(MVI)after anatomic liver resection.Methods A retrospective analysis was conducted on clinical data of 106 patients who underwent anatomic liver resection for HCC with MVI from Mar.2017 to Jun.2021 at the First People's Hospital of Neijiang.Patients were divided into the postoperative Tα1 treatment group(n=49)and postoperative conventional treatment group(n=57).The changes in peripheral blood T-lymphocyte subsets percentages and neutrophil-to-lymphocyte ratio(NLR)at 1,3,and 6 months postoperatively,the 1-year tumour recurrence rate and recurrence-free survival rate between the two groups were compared,and the prognostic factors affecting postoperative recurrence in HCC patients were analyzed.Results(1)In the Tα1 group,postoperative CD3+,CD4+,and CD4+/CD8+levels were significantly higher than those in the conventional group(F=10.336,16.541,16.397;P＜0.05).There was no statistically significant difference in postoperative CD8+between the two groups(F=0.638,P=0.426).One month postoperatively,CD3+,CD4+,and CD4/CD8+in the Tα1 group significantly increased(P＜0.05),and CD8+significantly decreased(P＜0.05).While in the conventional group,the significant increase of CD3+and CD4+(P＜0.05)and significant decrease of CD8+(P＜0.05)occurred 6 months postoperatively,CD4+/CD8+significantly increased at 3 and 6 months postoperatively(P＜0.05).(2)Compared with the conventional group,the Tα1 group showed a significantly higher rate of NLR decrease at 1,3,and 6 months postoperatively(x2=9.811,10.271,10.120;P＜0.05).(3)The 1-year tumour recurrence rate was 18.4％in the Tα1 group and 26.3％in the conventional group,with no statistically significant difference between the two groups(x2=0.950,P=0.330).(4)Compared with the conventional group,the Tα1 group demonstrated a superior recurrence-free survival rate(x2=4.348,P＜0.05).Multivariate Cox analysis revealed that postoperative Tα1 treatment was an independent prognostic factor affecting the postoperative recurrence in HCC patients(OR=0.554,95％CI 0.317-0.967,P=0.038).Conclusion By modulating the inflammation and immune status,postoperative Tα1 can enhance the recurrence-free survival rate of HCC patients complicated with MVI after anatomic liver resection,thereby can improve the overall prognosis of HCC patients.
钟平勇;刘欣;牟廷刚;卿明;谢飞
内江市第一人民医院 肝胆胰脾外科,四川 内江 641000
临床医学
肝细胞癌微血管侵犯解剖性肝切除术胸腺肽α1T淋巴细胞亚群中性粒细胞与淋巴细胞比值
hepatocellular carcinomamicrovascular invasionanatomical liver resectionthymosin α1T-lymphocyte subsetsneutrophil to lymphocyte ratio
《肝胆胰外科杂志》 2024 (001)
7-12 / 6
内江市科技计划项目(Z202132).
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